Gardner R S, Henderson G, McDonagh T A
Department of Cardiology, University of Glasgow, Glasgow, UK.
J Heart Lung Transplant. 2005 Mar;24(3):303-9. doi: 10.1016/j.healun.2004.01.010.
Right heart catheterization long has been a routine investigation in advanced heart failure, and its measurements have been linked variably to prognosis. However, in the modern era, newer potential markers of prognosis are coming to light. This study reconsiders the use of right heart catheterization data and compares their use to that of N-terminal pro-brain natriuretic peptide (NT-proBNP), a neurohormone linked with prognosis in chronic heart failure.
We assessed prospectively the prognostic potential of baseline right heart catheterization data in 97 consecutive patients with advanced heart failure referred to the Scottish Cardiopulmonary Transplant Unit for consideration of cardiac transplantation. Patients underwent baseline routine investigation, including right heart catheterization and blood draws for NT-proBNP analysis. Patients were observed for a median of 370 days.
The primary end-point of all-cause mortality was reached in 17 patients (17.5%), and the secondary end-point of all-cause mortality or urgent cardiac transplantation was reached in 21 (21.6%) patients. Univariate predictors of all-cause mortality included pulmonary artery systolic pressure (PASP), pulmonary artery wedge pressure (PAWP), and NT-proBNP concentration greater than their median values. Univariate predictors of the secondary end-point included right atrial pressure, PASP, PAWP, and NT-proBNP concentration greater than their median values, and left ventricular ejection fraction, cardiac output, and cardiac index less than their median values. In multivariate analyses, however, only NT-proBNP concentration remained an independent predictor of all-cause mortality. Both NT-proBNP concentration and PAWP were independent predictors of all-cause mortality and of the need for urgent cardiac transplantation.
Baseline data from routine right heart catheterization are of limited prognostic use in advanced heart failure. A baseline NT-proBNP concentration is a superior, non-invasive method of risk stratification in this era of measuring neurohormones.
右心导管检查长期以来一直是晚期心力衰竭的常规检查，其测量结果与预后的关联存在差异。然而，在现代，新的潜在预后标志物不断涌现。本研究重新审视了右心导管检查数据的用途，并将其与N末端脑钠肽前体（NT-proBNP）的用途进行比较，NT-proBNP是一种与慢性心力衰竭预后相关的神经激素。
我们前瞻性评估了97例连续转诊至苏格兰心肺移植单位考虑心脏移植的晚期心力衰竭患者基线右心导管检查数据的预后潜力。患者接受了包括右心导管检查和采集血样进行NT-proBNP分析在内的基线常规检查。对患者进行了中位370天的观察。
17例患者（17.5%）达到全因死亡率的主要终点，21例患者（21.6%）达到全因死亡率或紧急心脏移植的次要终点。全因死亡率的单变量预测因素包括肺动脉收缩压（PASP）、肺动脉楔压（PAWP）以及高于中位数的NT-proBNP浓度。次要终点的单变量预测因素包括右心房压力、PASP、PAWP以及高于中位数的NT-proBNP浓度，还有低于中位数的左心室射血分数、心输出量和心脏指数。然而，在多变量分析中，只有NT-proBNP浓度仍然是全因死亡率的独立预测因素。NT-proBNP浓度和PAWP都是全因死亡率以及紧急心脏移植需求的独立预测因素。
常规右心导管检查的基线数据在晚期心力衰竭中的预后用途有限。在这个测量神经激素的时代，基线NT-proBNP浓度是一种更优的、非侵入性的风险分层方法。
