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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I read the article by Platek et al&#46; in the recent issue of your journal with great interest&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In their study&#44; the authors reported that deceased patients had higher levels of N-terminal pro-B-type natriuretic peptide &#40;NT-proBNP&#41; and higher troponin I concentrations on the third measurement than survivors&#44; in patients with in-hospital cardiac arrest within 12 hours of admission&#46; They also reported that these findings may be predictors for mortality&#46; In the study by Platek et al&#46; all patients had reduced ejection fraction&#59; patients in the non-survivor group were older and had lower estimated glomerular filtration rate &#40;eGFR&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Mortality predictors in heart failure with reduced ejection fraction are well known&#46; In a large study which investigated these predictors&#44; it was reported that older age and lower eGFR were the most powerful&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Also in this study&#44; older age had a higher correlation with mortality than ejection fraction&#46; In the study by Platek et al&#46; non-surviving patients had lower systolic and diastolic blood pressure levels&#46; It is known that in-hospital hypotension is associated with increased mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Therefore&#44; older age&#44; lower eGFR and lower blood pressure levels may be stronger predictors of mortality than NT-proBNP levels in the study by Platek et al&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">There are no data on New York Heart Association &#40;NYHA&#41; class in the study by Platek et al&#46; NT-proBNP levels are positively correlated with NYHA class&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and patients with NYHA class III and IV have higher mortality than those with NYHA class II&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The authors should comment on the NYHA class of both groups&#44; since there may be more patients with NYHA class III and IV in the non-survivor group than in the survivor group&#46; In this sense&#44; comparison of groups regarding their NT-proBNP levels may not be the best approach&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In the study by Platek et al&#46; the authors reported that troponin I levels were higher on the third measurement in the non-survivor group&#46; This measurement was made 12&#8211;24 hours after admission&#44; meaning that it was made after cardiopulmonary resuscitation &#40;CPR&#41;&#46; In the study&#44; there are no data on CPR duration in the two groups&#46; It has been shown that longer duration of CPR is associated with higher troponin I levels&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> The higher troponin I levels on the third measurement may therefore be due to longer CPR duration in the non-survivor group&#46; The authors should comment on CPR duration in both groups to determine the exact significance of higher levels of troponin I on the third measurement&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; NT-proBNP may indicate high-risk patients&#46; However&#44; the statistical data of this study could be improved&#46; To confirm NT-proBNP and higher troponin levels as predictors of mortality&#44; a multivariate analysis should be performed including age&#44; eGFR and blood pressure levels&#46; Also&#44; the duration of CPR in both groups should be specified&#46;</p></span>"
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Letter to the Editor
We need more data to determine the significance of NT-proBNP and troponin I levels in high-risk patients
Precisamos de mais dados para determinar a importância dos níveis de NT-proBNP e de troponina em pacientes de alto risco
Mehmet Eyuboglu
Department of Cardiology, Dinar State Hospital Dinar, Afyonkarahisar, Turkey
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I read the article by Platek et al&#46; in the recent issue of your journal with great interest&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In their study&#44; the authors reported that deceased patients had higher levels of N-terminal pro-B-type natriuretic peptide &#40;NT-proBNP&#41; and higher troponin I concentrations on the third measurement than survivors&#44; in patients with in-hospital cardiac arrest within 12 hours of admission&#46; They also reported that these findings may be predictors for mortality&#46; In the study by Platek et al&#46; all patients had reduced ejection fraction&#59; patients in the non-survivor group were older and had lower estimated glomerular filtration rate &#40;eGFR&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Mortality predictors in heart failure with reduced ejection fraction are well known&#46; In a large study which investigated these predictors&#44; it was reported that older age and lower eGFR were the most powerful&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Also in this study&#44; older age had a higher correlation with mortality than ejection fraction&#46; In the study by Platek et al&#46; non-surviving patients had lower systolic and diastolic blood pressure levels&#46; It is known that in-hospital hypotension is associated with increased mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Therefore&#44; older age&#44; lower eGFR and lower blood pressure levels may be stronger predictors of mortality than NT-proBNP levels in the study by Platek et al&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">There are no data on New York Heart Association &#40;NYHA&#41; class in the study by Platek et al&#46; NT-proBNP levels are positively correlated with NYHA class&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and patients with NYHA class III and IV have higher mortality than those with NYHA class II&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The authors should comment on the NYHA class of both groups&#44; since there may be more patients with NYHA class III and IV in the non-survivor group than in the survivor group&#46; In this sense&#44; comparison of groups regarding their NT-proBNP levels may not be the best approach&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In the study by Platek et al&#46; the authors reported that troponin I levels were higher on the third measurement in the non-survivor group&#46; This measurement was made 12&#8211;24 hours after admission&#44; meaning that it was made after cardiopulmonary resuscitation &#40;CPR&#41;&#46; In the study&#44; there are no data on CPR duration in the two groups&#46; It has been shown that longer duration of CPR is associated with higher troponin I levels&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> The higher troponin I levels on the third measurement may therefore be due to longer CPR duration in the non-survivor group&#46; The authors should comment on CPR duration in both groups to determine the exact significance of higher levels of troponin I on the third measurement&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; NT-proBNP may indicate high-risk patients&#46; However&#44; the statistical data of this study could be improved&#46; To confirm NT-proBNP and higher troponin levels as predictors of mortality&#44; a multivariate analysis should be performed including age&#44; eGFR and blood pressure levels&#46; Also&#44; the duration of CPR in both groups should be specified&#46;</p></span>"
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ISSN: 08702551
Idioma original: Inglês
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