Corell Pernille, Gustafsson Finn, Kistorp Caroline, Madsen Lene Helleskov, Schou Morten, Hildebrandt Per
Department of Cardiology and Endocrinology E, Frederiksberg University Hospital, Ndr. Fasanvej 57, 2000 Frederiksberg, Denmark.
Int J Cardiol. 2007 May 2;117(3):395-402. doi: 10.1016/j.ijcard.2006.03.084. Epub 2006 Aug 17.
Brain natriuretic peptides are elevated in patients with systolic heart failure (HF) as well as in patients with atrial fibrillation (AF) and normal left ventricular ejection fraction (LVEF) and are strong predictors of death in HF patients. The aim of our study was to examine the levels of N-terminal pro brain natriuretic peptide (NT-proBNP) in patients with HF and AF versus HF and sinus rhythm (SR) and if NT-proBNP has prognostic influence in patients with AF.
We included 245 patients (72% men, 70 years) with HF referred to a HF clinic. NT-proBNP was measured at referral (baseline).
At baseline, 26% had AF and at follow-up 35% of the surviving patients. Patients with AF were older than patients with SR (p=0.009), but LVEF and NYHA distribution were similar. Median NT-proBNP levels were higher: 2528 vs. 899 pg/ml (p<0.001). NT-proBNP was significantly correlated with AF at baseline (p<0.001), age (p=0.001), P-creatinine (p<0.001) and reduced LVEF (p=0.002). NT-proBNP was an independent predictor of death in patients with AF, adjusted HR 4.0 (95% CI 1.6-10.2) (p=0.003).
NT-proBNP levels are higher in HF patients with AF than in HF patients with SR and has prognostic value despite the presence of AF.
脑钠肽在收缩性心力衰竭（HF）患者以及心房颤动（AF）且左心室射血分数（LVEF）正常的患者中升高，并且是HF患者死亡的强预测指标。我们研究的目的是检测HF合并AF患者与HF合并窦性心律（SR）患者的N末端脑钠肽原（NT-proBNP）水平，以及NT-proBNP对AF患者是否具有预后影响。
我们纳入了245例转诊至HF门诊的HF患者（72%为男性，年龄70岁）。在转诊时（基线）测量NT-proBNP。
基线时，26%的患者有AF，随访时存活患者中有35%有AF。AF患者比SR患者年龄更大（p=0.009），但LVEF和纽约心脏协会（NYHA）分级分布相似。NT-proBNP中位数水平更高：2528 vs. 899 pg/ml（p<0.001）。NT-proBNP在基线时与AF（p<0.001）、年龄（p=0.001）、血肌酐（p<0.001）和LVEF降低（p=0.002）显著相关。NT-proBNP是AF患者死亡的独立预测指标，校正后风险比为4.0（95%置信区间1.6-10.2）（p=0.003）。
HF合并AF患者的NT-proBNP水平高于HF合并SR患者，并且尽管存在AF仍具有预后价值。
