Jourdain Patrick, Jondeau Guillaume, Funck François, Gueffet Pascal, Le Helloco Alain, Donal Erwan, Aupetit Jean F, Aumont Marie C, Galinier Michel, Eicher Jean C, Cohen-Solal Alain, Juillière Yves
René Descartes University, Paris, France.
J Am Coll Cardiol. 2007 Apr 24;49(16):1733-9. doi: 10.1016/j.jacc.2006.10.081. Epub 2007 Apr 2.
The aim of this multicenter study was to evaluate the prognostic impact of a therapeutic strategy using plasma brain natriuretic peptide (BNP) levels.
The prognosis of chronic heart failure (CHF) remains poor, even among patients treated in specialized departments.
A total of 220 New York Heart Association functional class II to III patients considered optimally treated with angiotensin-converting enzyme inhibitors (ACEIs), beta-blockers, and diuretics by CHF specialists were randomized to medical treatment according to either current guidelines (clinical group) or a goal of decreasing BNP plasma levels <100 pg/ml (BNP group). Outpatient visits were scheduled every month for 3 months, then every 3 months. The primary combined end point was CHF-related death or hospital stay for CHF.
Both groups were similar for baseline clinical and biological characteristics. Left ventricular ejection fraction was slightly lower in the BNP group than in the clinical group (29.9 +/- 7.7% vs. 31.8 +/- 8.4%, p = 0.05). At the end of the first 3 months, all types of drugs were changed more frequently in the BNP group. Mean dosages of ACEIs and beta-blockers were significantly higher in the BNP group (p < 0.05), whereas the mean increase in furosemide dosage was similar in both groups. During follow-up (median 15 months), significantly fewer patients reached the combined end point in the BNP group (24% vs. 52%, p < 0.001).
In optimally treated CHF patients, a BNP-guided strategy reduced the risk of CHF-related death or hospital stay for CHF. The result was mainly obtained through an increase in ACEI and beta-blocker dosages.
这项多中心研究的目的是评估使用血浆脑钠肽（BNP）水平的治疗策略对预后的影响。
即使在专科治疗的患者中，慢性心力衰竭（CHF）的预后仍然很差。
共有220例纽约心脏协会心功能II至III级的患者，被CHF专家认为已用血管紧张素转换酶抑制剂（ACEI）、β受体阻滞剂和利尿剂进行了最佳治疗，根据现行指南（临床组）或使BNP血浆水平降至<100 pg/ml的目标（BNP组）随机分为药物治疗组。门诊随访计划为前3个月每月1次，之后每3个月1次。主要联合终点是CHF相关死亡或因CHF住院。
两组在基线临床和生物学特征方面相似。BNP组的左心室射血分数略低于临床组（29.9±7.7%对31.8±8.4%，p = 0.05）。在最初3个月结束时，BNP组各类药物的更换更为频繁。BNP组ACEI和β受体阻滞剂的平均剂量显著更高（p < 0.05），而两组呋塞米剂量的平均增加相似。在随访期间（中位时间15个月），BNP组达到联合终点的患者明显较少（24%对52%，p < 0.001）。
在接受最佳治疗的CHF患者中，BNP指导策略降低了CHF相关死亡或因CHF住院的风险。这一结果主要是通过增加ACEI和β受体阻滞剂的剂量获得的。
