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接受或未接受布新洛尔治疗的充血性心力衰竭患者的基线及系列神经激素：β受体阻滞剂生存评估研究（BEST）神经体液亚研究结果

Baseline and serial neurohormones in patients with congestive heart failure treated with and without bucindolol: results of the neurohumoral substudy of the Beta-Blocker Evaluation of Survival Study (BEST).

作者信息

Frantz Robert P, Lowes Brian D, Grayburn Paul A, White Michel, Krause-Steinrauf Heidi, Krishnan Vaishali, Uyeda Lauren, Burnett John C

机构信息

Division of Cardiovascular Diseases, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, Minnesota 55905, USA.

出版信息

J Card Fail. 2007 Aug;13(6):437-44. doi: 10.1016/j.cardfail.2007.03.007.

DOI:10.1016/j.cardfail.2007.03.007

PMID:17675057

Abstract

BACKGROUND

Serial neurohormones may serve as markers of efficacy of congestive heart failure (CHF) therapy. We measured serial plasma big-endothelin (Big-ET), ET-1, N-terminal atrial natriuretic peptide, and brain natriuretic peptide (BNP) in 206 patients randomized to bucindolol or placebo in Beta-Blocker Evaluation of Survival Trial (BEST).

METHODS AND RESULTS

Neurohormones were measured at baseline and 3 and 12 months. At baseline, BNP and Big-ET levels were greater in New York Heart Association (NYHA) Class IV than in Class III patients (median 122 pg/mL versus 447 pg/mL, P = .001; and 20.0 pg/mL versus 9.9 pg/mL, P = .003), and in patients with left ventricular ejection fraction (LVEF) < or = 20% compared with LVEF > 20% (median 211 pg/mL versus 99.1 pg/mL; and 12.9 pg/mL versus 8.0 pg/mL, both P = .003). Big-ET and BNP were the strongest predictors of the composite end point of CHF hospitalization or death. LVEF at 12 months correlated inversely with 12-month BNP levels (r = -0.41, P = .0001). Bucindolol had no effect on neurohormones except that bucindolol treated patients had lower Big-ET levels at 3 months than patients receiving placebo (median 9.1 pg/mL versus 10.9 pg/mL, P = .05). A decline in ET-1 was associated with increased risk of the composite endpoint.

CONCLUSIONS

Lack of effect of bucindolol on natriuretic peptide levels appears consistent with its overall lack of efficacy in BEST.

摘要

背景

系列神经激素可作为充血性心力衰竭（CHF）治疗效果的标志物。在β受体阻滞剂生存评估试验（BEST）中，我们对206例随机接受布辛多洛或安慰剂治疗的患者进行了系列血浆大内皮素（Big-ET）、内皮素-1（ET-1）、N末端心房利钠肽及脑利钠肽（BNP）的测定。

方法与结果

在基线、3个月及12个月时测定神经激素水平。基线时，纽约心脏协会（NYHA）IV级患者的BNP和Big-ET水平高于III级患者（中位数分别为122 pg/mL对447 pg/mL，P = 0.001；20.0 pg/mL对9.9 pg/mL，P = 0.003），左心室射血分数（LVEF）≤20%的患者高于LVEF＞20%的患者（中位数分别为211 pg/mL对99.1 pg/mL；12.9 pg/mL对8.0 pg/mL，P均 = 0.003）。Big-ET和BNP是CHF住院或死亡复合终点的最强预测因子。12个月时的LVEF与12个月时的BNP水平呈负相关（r = -0.41，P = 0.0001）。布辛多洛对神经激素无影响，仅布辛多洛治疗的患者在3个月时的Big-ET水平低于接受安慰剂的患者（中位数分别为9.1 pg/mL对10.9 pg/mL，P = 0.05）。ET-1下降与复合终点风险增加相关。