Rienstra Michiel, Van Gelder Isabelle C, Van den Berg Maarten P, Boomsma Frans, Van Veldhuisen Dirk J
Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Europace. 2006 Jul;8(7):482-7. doi: 10.1093/europace/eul060.
To study the determinants of natriuretic peptides in advanced chronic heart failure (CHF) patients with and without atrial fibrillation (AF) and to evaluate the prognostic value of natriuretic peptides in AF compared with sinus rhythm patients with advanced CHF.
The study group comprised 354 advanced CHF patients [all New York Heart Association (NYHA) III/IV], including 76 AF patients. AF patients were older (70+/-7 vs. 67+/-8; P=0.01), and non-ischaemic CHF was more common (42 vs. 19%; P=0.002) than in sinus rhythm patients, but left-ventricular ejection fraction was comparable (0.23+/-0.08 vs. 0.24+/-0.07; P=ns). At baseline, (NT-)ANP and NT-proBNP levels were significantly higher in AF patients, compared with those in sinus rhythm. By multivariate regression analysis, AF was identified as independent determinant of (NT-)ANP, but not of (NT-pro)BNP levels. After a mean follow-up of 3.2+/-0.9 (range 0.4-5.4) years, cardiovascular mortality was comparable (55 vs. 47%; P=ns). In both groups, AF and sinus rhythm, NT-proBNP [AF: adjusted HR 5.8 (1.3-25.4), P=0.02; sinus rhythm: adjusted HR 3.1 (1.7-5.7), P<0.001] was an independent risk indicator of cardiovascular mortality.
In advanced CHF patients, AF affects (NT-)ANP levels, but not (NT-pro)BNP levels. NT-proBNP is an independent determinant of prognosis in advanced CHF, irrespective of the rhythm, AF, or sinus rhythm.
研究伴或不伴有心房颤动（AF）的晚期慢性心力衰竭（CHF）患者中利钠肽的决定因素，并评估与晚期CHF窦性心律患者相比，利钠肽在AF中的预后价值。
研究组包括354例晚期CHF患者[均为纽约心脏协会（NYHA）III/IV级]，其中76例为AF患者。AF患者年龄更大（70±7岁对67±8岁；P=0.01），非缺血性CHF比窦性心律患者更常见（42%对19%；P=0.002），但左心室射血分数相当（0.23±0.08对0.24±0.07；P=无显著性差异）。基线时，与窦性心律患者相比，AF患者的（NT-）ANP和NT-proBNP水平显著更高。通过多变量回归分析，AF被确定为（NT-）ANP的独立决定因素，但不是（NT-pro）BNP水平的独立决定因素。平均随访3.2±0.9（范围0.4 - 5.4）年之后，心血管死亡率相当（55%对47%；P=无显著性差异）。在AF和窦性心律两组中，NT-proBNP[AF：校正风险比5.8（1.3 - 25.4），P=0.02；窦性心律：校正风险比3.1（1.7 - 5.7），P<0.001]是心血管死亡的独立风险指标。
在晚期CHF患者中，AF影响（NT-）ANP水平，但不影响（NT-pro）BNP水平。NT-proBNP是晚期CHF预后的独立决定因素，无论心律是AF还是窦性心律。
