EUR HEART J:NT-proBNP有效预测肥厚型心肌病患者预后
2013-03-05 高晓方 译 医学论坛网
英国学者的一项研究表明,在肥厚型心肌病(HCM)患者中,N端脑利钠肽前体(NT-proBNP)浓度升高为总体预后的有效预测因子。论文于2013年3月1日在线发表于《欧洲心脏杂志》(Eur Heart J)。 此项研究共纳入847例HCM患者。受试者年龄为53 ± 15岁,67%为男性,28%伴有静息左室流出道梗阻≥30 mmHg。中位随访
英国学者的一项研究表明,在肥厚型心肌病(HCM)患者中,N端脑利钠肽前体(NT-proBNP)浓度升高为总体预后的有效预测因子。论文于2013年3月1日在线发表于《欧洲心脏杂志》(Eur Heart J)。
此项研究共纳入847例HCM患者。受试者年龄为53 ± 15岁,67%为男性,28%伴有静息左室流出道梗阻≥30 mmHg。中位随访时间为3.5年。主要终点为全因死亡或心脏移植。
结果显示,中位NT-proBNP浓度为78 pmol/L。8%(68例)的受试者达到主要终点。血浆NT-proBNP浓度可预测远期生存率。血清NT-proBNP浓度≥135 pmol/L与年度事件发生率6.1%相关。在多变量Cox模型中,NYHA分级III/IV(P = 0.008)、射血分数(P = 0.035)和log NT-proBNP(P < 0.001)为主要转归的独立预测因素。log NT-proBNP为心衰和移植相关性死亡的显著预测因子(P < 0.001),但无法预测猝死或ICD休克(P = 0.111)。在射血分数≥50%的患者中,log NT-proBNP仍为主要转归的主要预测因子(P < 0.001)。
与心肌病相关的拓展阅读:
- HEART RHYTHM :致心律失常性心肌病患者或存在心肌信号传导紊乱
- Circulation:肥厚性心肌病遗传外显率调查
- 靶向心肌重构与损伤 推进心肌病防治
- JBC:DES基因触发心律失常性右心室心肌病
- Nature:心脏血管生成失衡导致围产期心肌病 更多信息请点击:有关心肌病更多威廉亚洲官网
Aims
To determine the relation between serum concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) and prognosis in patients with hypertrophic cardiomyopathy (HCM).
Methods and results
In total, 847 patients (53 ± 15 years; 67% male) with HCM (28% with left ventricular outflow tract obstruction ≥30 mmHg at rest) were followed for 3.5 years (IQR 2.5–4.5 years). The median NT-proBNP concentration was 78 pmol/L (range <5–1817 pmol/L and IQR 31−183 pmol/L). Sixty-eight patients (8%) reached the primary endpoint of all-cause mortality or cardiac transplantation. Plasma NT-proBNP concentration predicted long-term survival from the primary endpoint [area under the receiver operating characteristic curve of 0.78 (95% confidence interval 0.73−0.84)]. A serum concentration of ≥135 pmol/L was associated with an annual event rate of 6.1% (95% CI 4.4−7.7). Three independent predictors of primary outcome were identified in a multivariable Cox model: New York Heart Association class III/IV (HR 2.10, 95% CI 1.21−3.65, P = 0.008), ejection fraction (HR 0.98, 95% CI 0.96−1.00, P = 0.035), log NT-proBNP (HR 2.04, 95% CI 1.56−2.66, P < 0.001). Log NT-proBNP was a significant predictor of heart failure (HF) and transplant-related deaths (n = 23; HR 3.03, 95% CI 1.99−4.60, P < 0.001) but not sudden death or appropriate implantable cardioverter defibrillator shock (n = 11; HR 1.54, 95% CI 0.91−2.60, P = 0.111). In patients with ejection fraction ≥50% (n = 673), log NT-proBNP remained an independent predictor of the primary outcome (HR 2.11, 95% CI 1.54−2.90, P < 0.001).
Conclusion
In patients with HCM, elevated NT-proBNP concentration is a strong predictor of overall prognosis, particularly HF-related death and transplantation.
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#患者预后#
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#BNP#
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#NT-proBNP#
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#ART#
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#肌病#
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