Gardner Roy S, Chong Kwok S, Morton James J, McDonagh Theresa A
Department of Cardiology, Glasgow Royal Infirmary, Glasgow, UK.
Eur J Heart Fail. 2007 Mar;9(3):266-71. doi: 10.1016/j.ejheart.2006.07.002. Epub 2006 Oct 4.
The prognosis of chronic heart failure has improved with modern medical therapy. However, identifying those patients who fail to respond to such therapy and therefore those who remain at high risk is notoriously difficult. The B-type natriuretic peptides are established independent predictors of prognosis in CHF. However, the relevance of a change in NT-proBNP concentration over time in advanced heart failure is unknown.
We prospectively studied 133 patients with advanced CHF referred for consideration of cardiac transplantation. Plasma for NT-proBNP analysis was sampled at baseline and a median of 4 months later in the 112 patients surviving without cardiac transplantation. Patients were followed up for a median of 1003 days.
The primary endpoint of all-cause mortality occurred in 30 (26.8%) patients. Those subjects who had the highest NT-proBNP concentration at 4 months were at the greatest risk of death (log rank statistic=10.4, p=0.001). On Cox regression analysis, both a NT-proBNP concentration above the median and an absolute increase in NT-proBNP were independent predictors of mortality (chi(2)=53, p<0.0001 and chi(2)=17.3, p<0.0001, respectively).
A single NT-proBNP concentration above the median and a change in NT-proBNP concentration over a 4-month period were independent predictors of mortality in patients with advanced heart failure.
现代医学治疗已改善了慢性心力衰竭的预后。然而，识别那些对这种治疗无反应从而仍处于高风险的患者极其困难。B型利钠肽是慢性心力衰竭预后已确立的独立预测指标。然而，在晚期心力衰竭中，NT-proBNP浓度随时间变化的相关性尚不清楚。
我们前瞻性地研究了133例因考虑心脏移植而转诊的晚期慢性心力衰竭患者。在基线时以及在112例未接受心脏移植而存活的患者中，于中位数4个月后采集用于NT-proBNP分析的血浆。对患者进行了中位数为1003天的随访。
30例（26.8%）患者发生了全因死亡这一主要终点事件。那些在4个月时NT-proBNP浓度最高的受试者死亡风险最大（对数秩检验统计量=10.4，p=0.001）。在Cox回归分析中，NT-proBNP浓度高于中位数以及NT-proBNP的绝对升高均是死亡率的独立预测指标（分别为χ²=53，p<0.0001和χ²=17.3，p<0.0001）。
NT-proBNP浓度高于中位数以及4个月期间NT-proBNP浓度的变化是晚期心力衰竭患者死亡率的独立预测指标。
