Supplements Affect NT

by Crystal Phend, Senior Associate Editor, MedPage Today September 29, 2017

This article is a collaboration between MedPage Today and:

Common over-the-counter doses of biotin supplements -- popular for hair growth, lipid disorders, and other presumptive benefits -- interfere with assays for N-terminal pro-brain natriuretic peptide (NT-proBNP) and other common analytes in blood, researchers reported in the Journal of the American Medical Association. Biotinylated reagents are frequently used in clinical chemistry.

One week of use in the small crossover trial reduced OCD Vitros 5600 NT-proBNP results by an average of more than 13.9 pg/mL, to levels less than 11.1 pg/mL in all participants.

That effect of "falsely decreased OCD Vitros N-terminal pro-brain natriuretic peptide, to lower than assay detection limits, could possibly result in failure to identify congestive heart failure," the researchers warned.

"Clinicians may want to ask about biotin ingestion even if assay results are not suspect because biotin interferences can cause either falsely normal or abnormal results. It may be advisable for patients to stop taking biotin, preferably for a week as studied herein, before undergoing laboratory testing. Alternatively, in the presence of biotin ingestion, non-biotinylated assays would be preferred."

See the full story at MedPage Today here.

Cord Stem Cells for Heart Failure

Stable heart failure patients given umbilical cord-derived stem cells (from full-term human placentas from consenting healthy donors who delivered by caesarean section) showed improved ventricular function in a small randomized trial reported in Circulation Research.

The IV infusions significantly improved left ventricular ejection fraction at 3, 6, and 12 months by both transthoracic echocardiography and cardiac magnetic resonance imaging, with more than a five percentage point advantage over placebo at 12 months. New York Heart Association functional class and quality of life improved as well with the stem cells, without adverse effects or antibody development.

Low-Risk ER Chest Pain Strategy

A strategy for discharge without a stress test appeared safe for low-risk patients presenting to the emergency department with chest pain, according to a small randomized trial reported in Circulation: Cardiovascular Quality and Outcomes.

Patients with a modified HEART score ≤3, which includes cardiac troponin I less than 0.04 ng/mL at 0 and 3 hours, randomized to immediate discharge spent a median of 6.3 hours in the hospital versus 25.9 hours for those with management in an observation unit with stress testing. Median total charges for care were $2,953 versus $9,616 respectively.

The Henry Ford HEART Study researchers said the results have "tremendous potential national healthcare expenditure implications."

Neither group of patients had any deaths, acute myocardial infarctions, or coronary revascularizations at 30 days. However, larger trials will be needed to definitively prove the safety of the strategy, the team acknowledged.

In Other News

With more standardized terminology and clinical organization, extracorporeal organ support could "evolve from a device for use only as a last resort to a technique that is used as part of an advanced strategy for treating patients with severe organ failure," a viewpoint article summarizing a roundtable meeting of experts said in the Journal of the American Medical Association.

Adjusting for do-not-resuscitate orders has a big impact on heart failure mortality rates as a hospital-level quality measure, according to a study reported in JACC: Heart Failure. See MedPage Today's full coverage here.