Isnard Richard, Pousset Françoise, Chafirovskaïa Olga, Carayon Alain, Hulot Jean Sébastien, Thomas Daniel, Komajda Michel
Service de Cardiologie, Institut Fédératif de Recherche 14 Heart, vessels, muscle UPRES EA 2390, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.
Am Heart J. 2003 Oct;146(4):729-35. doi: 10.1016/S0002-8703(03)00365-X.
Peak oxygen consumption is a cornerstone for prognostic determination in patients with congestive heart failure. The purpose of this study was to assess whether plasma B-type natriuretic peptide (BNP) provided any additional prognostic information.
Plasma concentrations of atrial natriuretic peptide, N terminal pro-atrial natriuretic peptide, BNP, endothelin-1, norepinephrine, and peak VO2 were measured in 250 consecutive outpatients with mild to moderate heart failure (96% in New York Heart Association [NYHA] class II or III) and left ventricular ejection fraction (LVEF) <45%.
During a median follow-up of 584 days, 42 patients died (19 from sudden death) and 5 underwent urgent heart transplantation. Multivariate stepwise regression analysis showed that, among 13 variables including NYHA and LVEF, plasma BNP (chi2 = 11.9, P =.0001) was the strongest independent predictor of death or urgent transplantation, followed by serum sodium (chi2 = 8, P =.0046), resting heart rate (chi2 = 7.5, P =.0062), plasma endothelin-1 (chi2 = 7.2, P =.007), and peak VO2 (chi2 = 6.2, P =.012). Patients with plasma BNP above the upper quartile value (260 pg/mL) had a 1-year rate of death or urgent transplantation of 31%. The 1- and 2-year survival rates without urgent transplantation in patients with a peak VO2 < or =14 mL x kg(-1) x min(-1) were 71% and 59%, respectively, when plasma BNP was >137 pg/mL (median value), compared with 100% and 89%, respectively, when plasma BNP was < or =137 pg/mL (P =.008). Furthermore, plasma BNP was the only independent predictor of sudden death (chi2 = 19.9, P =.00001).
Plasma BNP provides additive independent prognostic information compared to peak VO2 alone in outpatients with mild to moderate heart failure.
峰值耗氧量是充血性心力衰竭患者预后判定的基石。本研究的目的是评估血浆B型利钠肽（BNP）是否能提供额外的预后信息。
对250例连续的轻至中度心力衰竭门诊患者（纽约心脏协会[NYHA] II或III级患者占96%）且左心室射血分数（LVEF）<45%，测定其血浆心房利钠肽、N末端前心房利钠肽、BNP、内皮素-1、去甲肾上腺素和峰值VO2的浓度。
在中位随访584天期间，42例患者死亡（19例猝死），5例接受了紧急心脏移植。多因素逐步回归分析显示，在包括NYHA和LVEF在内的13个变量中，血浆BNP（χ2 = 11.9，P = 0.0001）是死亡或紧急移植的最强独立预测因子，其次是血清钠（χ2 = 8，P = 0.0046）、静息心率（χ2 = 7.5，P = 0.0062）、血浆内皮素-1（χ2 = 7.2，P = 0.007）和峰值VO2（χ2 = 6.2，P = 0.012）。血浆BNP高于上四分位数（260 pg/mL）的患者1年死亡或紧急移植率为31%。当血浆BNP>137 pg/mL（中位数）时，峰值VO2≤14 mL·kg-1·min-1的患者无紧急移植的1年和2年生存率分别为71%和59%，而当血浆BNP≤137 pg/mL时，分别为100%和89%（P = 0.008）。此外，血浆BNP是猝死的唯一独立预测因子（χ2 = 19.9，P = 0.00001）。
在轻至中度心力衰竭门诊患者中，与单独的峰值VO2相比，血浆BNP可提供额外的独立预后信息。
