Störk Stefan, Boivin Valerie, Horf Rüdiger, Hein Lutz, Lohse Martin J, Angermann Christiane E, Jahns Roland
Department of Internal Medicine I/Center of Cardiovascular Medicine, University of Würzburg, Würzburg, Germany.
Am Heart J. 2006 Oct;152(4):697-704. doi: 10.1016/j.ahj.2006.05.004.
The aim of this study was to estimate the independent and incremental prognostic value of the presence of stimulating autoantibodies directed against the human beta1-adrenergic receptor (anti-beta1-AR) in patients with chronic heart failure.
One hundred five antibody-typed chronic heart failure patients with dilated cardiomyopathy (DCM, n = 65) or ischemic cardiomyopathy (ICM, n = 40) were prospectively followed for 10.7 +/- 2.5 years. Information on all-cause and cardiovascular mortality was collected throughout the observation period.
Stimulating anti-beta1-AR were prevalent in 26% (17/65) of patients with DCM and 13% (5/40) with ICM. All-cause mortality in antibody-positive patients was 65% in those with DCM and 80% in those with ICM, and in antibody-negative patients 44% and 49%, respectively. In univariate and multivariable Cox regression analysis (P < .05), presence of stimulating anti-beta1-AR was associated with increased all-cause and cardiovascular mortality risk in DCM but not in ICM. Information on antibody status improved the prognostic capacity in models containing already extensive information on clinical profile, Holter electrocardiography, and invasive hemodynamic measurements (area under the receiver operating characteristic curve, 0.91; 95% confidence interval, 0.85-0.97; P < .05 for increase in receiver operating characteristic area).
The presence of stimulating anti-beta1-AR autoantibodies independently predicts increased all-cause and cardiovascular mortality risk in DCM conferring incremental prognostic value in addition to established risk predictors. Our data indicate a clinical relevance of stimulating anti-beta1-AR in DCM and encourage further research into antibody-directed strategies as a therapeutic principle.
本研究旨在评估慢性心力衰竭患者中针对人β1-肾上腺素能受体的刺激性自身抗体（抗β1-AR）的独立及增量预后价值。
对105例抗体分型的慢性心力衰竭患者进行前瞻性随访，这些患者患有扩张型心肌病（DCM，n = 65）或缺血性心肌病（ICM，n = 40），随访时间为10.7±2.5年。在整个观察期内收集全因死亡率和心血管死亡率信息。
刺激性抗β1-AR在26%（17/65）的DCM患者和13%（5/40）的ICM患者中普遍存在。抗体阳性患者的全因死亡率在DCM患者中为65%，在ICM患者中为80%，而抗体阴性患者分别为44%和49%。在单因素和多因素Cox回归分析中（P < 0.05），刺激性抗β1-AR的存在与DCM患者全因和心血管死亡风险增加相关，但与ICM患者无关。抗体状态信息提高了包含临床特征、动态心电图和有创血流动力学测量等广泛信息的模型的预后能力（受试者工作特征曲线下面积，0.91；95%置信区间，0.85 - 0.97；受试者工作特征面积增加，P < 0.05）。
刺激性抗β1-AR自身抗体的存在独立预测DCM患者全因和心血管死亡风险增加，除既定风险预测指标外还具有增量预后价值。我们的数据表明刺激性抗β1-AR在DCM中具有临床相关性，并鼓励进一步研究以抗体为导向的策略作为治疗原则。
