比较中段心房利钠肽原与N末端B型利钠肽原在预测慢性心力衰竭患者生存率中的作用

Comparison of midregional pro-atrial natriuretic peptide with N-terminal pro-B-type natriuretic peptide in predicting survival in patients with chronic heart failure.

作者信息

von Haehling Stephan, Jankowska Ewa A, Morgenthaler Nils G, Vassanelli Corrado, Zanolla Luisa, Rozentryt Piotr, Filippatos Gerasimos S, Doehner Wolfram, Koehler Friedrich, Papassotiriou Jana, Kremastinos Dimitrios T, Banasiak Waldemar, Struck Joachim, Ponikowski Piotr, Bergmann Andreas, Anker Stefan D

机构信息

Applied Cachexia Research, Department of Cardiology, Charité Medical School, Berlin, Germany.

出版信息

J Am Coll Cardiol. 2007 Nov 13;50(20):1973-80. doi: 10.1016/j.jacc.2007.08.012. Epub 2007 Oct 29.

DOI:10.1016/j.jacc.2007.08.012

PMID:17996563

Abstract

OBJECTIVES

Our aim was assess the prognostic value of midregional pro-atrial natriuretic peptide (MR-proANP) using a new immunoassay in patients with chronic heart failure (HF).

BACKGROUND

Assessment of natriuretic peptides represents a useful addition in establishing the diagnosis of chronic HF. Their plasma values are powerful predictors of survival in chronic HF.

METHODS

We assessed MR-proANP in 525 chronic HF patients (derivation study: age 61 +/- 12 years, New York Heart Association (NYHA) functional class I/II/III/IV 6%/44%/41%/9%, N-terminal pro-B-type natriuretic peptide (NT-proBNP) 3,637 +/- 6,362 pg/ml) and validated our findings in 249 additional chronic HF patients (age 63 +/- 9 years, NYHA functional class I/II/III/IV 14%/50%/33%/3%, NT-proBNP 1,116 +/- 1,991 pg/ml).

RESULTS

The MR-proANP levels (mean 339 +/- 306 pmol/l, range 24.5 to 2,280 pmol/l) increased with NYHA functional class (p < 0.0001). During follow-up (>6 months in survivors), 171 patients (33%) died. Increasing MR-proANP was a predictor of poor survival (risk ratio 1.35 per increase in standard deviation, 95% confidence interval 1.17 to 1.57; p = 0.0061), adjusted for NT-proBNP, age, left ventricular ejection fraction, NYHA functional class, creatinine, and body mass index (BMI). In receiver operating characteristic curve analysis of 12-month survival, the area under the curve for MR-proANP was 0.74 and that of NT-proBNP was 0.75 (p = 0.7). In a validation study, MR-proANP levels above the optimal prognostic cutoff value from the validation cohort remained a significant independent predictor of death. In chronic HF patients in NYHA functional class II to III and all subgroups of BMI and kidney function, MR-proANP added prognostic value to NT-proBNP. In patients with BMI > or =30 kg/m2, MR-proANP had higher prognostic power than NT-proBNP.

CONCLUSIONS

Midregional proANP is an independent predictor of mortality in patients with chronic HF. Midregional proANP adds prognostic information to NT-proBNP.

摘要

目的

我们旨在使用一种新的免疫测定法评估中段心房利钠肽前体（MR-proANP）对慢性心力衰竭（HF）患者的预后价值。

背景

利钠肽的评估在慢性HF的诊断中是一项有用的补充。其血浆水平是慢性HF患者生存的有力预测指标。

方法

我们评估了525例慢性HF患者的MR-proANP（推导研究：年龄61±12岁，纽约心脏协会（NYHA）心功能分级I/II/III/IV分别为6%/44%/41%/9%，N末端B型利钠肽原（NT-proBNP）3,637±6,362 pg/ml），并在另外249例慢性HF患者（年龄63±9岁，NYHA心功能分级I/II/III/IV分别为14%/50%/33%/3%，NT-proBNP 1,116±1,991 pg/ml）中验证了我们的发现。

结果

MR-proANP水平（平均339±306 pmol/l，范围24.5至2,280 pmol/l）随NYHA心功能分级增加而升高（p<0.0001）。在随访期间（幸存者>6个月），171例患者（33%）死亡。MR-proANP升高是生存不良的预测指标（每增加一个标准差风险比为1.35，95%置信区间1.17至1.57；p = 0.0061），校正了NT-proBNP、年龄、左心室射血分数、NYHA心功能分级、肌酐和体重指数（BMI）。在12个月生存的受试者工作特征曲线分析中，MR-proANP的曲线下面积为0.74，NT-proBNP的曲线下面积为0.75（p = 0.7）。在一项验证研究中，高于验证队列最佳预后临界值的MR-proANP水平仍然是死亡的显著独立预测指标。在NYHA心功能分级II至III级的慢性HF患者以及BMI和肾功能的所有亚组中，MR-proANP为NT-proBNP增加了预后价值。在BMI≥30 kg/m2的患者中，MR-proANP的预后能力高于NT-proBNP。