Fonarow Gregg C, Peacock William F, Horwich Tamara B, Phillips Christopher O, Givertz Michael M, Lopatin Margarita, Wynne Janet
Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles Medical Center, Los Angeles, California, USA.
Am J Cardiol. 2008 Jan 15;101(2):231-7. doi: 10.1016/j.amjcard.2007.07.066. Epub 2007 Dec 3.
B-type natriuretic peptide (BNP) and cardiac troponin (Tn) I or T have been demonstrated to provide prognostic information in patients with acute coronary syndromes. Whether admission BNP and Tn levels provide additive prognostic value in acutely decompensated heart failure (HF) has not been well studied. Hospitalizations for HF from April 2003 to December 2004 entered into ADHERE were analyzed. BNP assessment on admission was performed in 48,629 (63%) of 77,467 hospitalization episodes. Tn assessment was performed in 42,636 (88%) of these episodes. In-hospital mortality was assessed using logistic regression models adjusted for age, gender, blood urea nitrogen, systolic blood pressure, creatinine, sodium, pulse, and dyspnea at rest. Median BNP was 840 pg/ml (interquartile range 430 to 1,730). Tn was increased in 2,370 (5.6%) of 42,636 HF episodes. BNP above the median and increased Tn were associated with significantly increased risk of in-hospital mortality (odds ratios [OR] 2.09 and 2.41 respectively, each p value <0.0001). Mortality was 10.2% in patients with BNP >or=840/Tn increased compared with 2.2% with BNP <840/Tn not increased (OR 5.10, p <0.0001). After covariate adjustment, mortality risk remained significantly increased with BNP >or=840/Tn not increased (adjusted OR 1.56, 95% confidence interval 1.40 to 1.79, p <0.0001), BNP <840/Tn increased (adjusted OR 1.69, 95% confidence interval 1.17 to 2.45, p = 0.006), and BNP >or=840/Tn increased (adjusted OR 3.00, 95% confidence interval 2.47 to 3.66, p <0.0001). Admission BNP and cardiac Tn levels are significant, independent predictors of in-hospital mortality in acutely decompensated HF. Patients with BNP levels >or=840 pg/ml and increased Tn levels are at particularly high risk for mortality. In conclusion, a multimarker strategy for the assessment of patients hospitalized with HF adds incremental prognostic information.
B型利钠肽（BNP）和心肌肌钙蛋白（Tn）I或Tn已被证明可为急性冠状动脉综合征患者提供预后信息。入院时BNP和Tn水平在急性失代偿性心力衰竭（HF）中是否具有附加预后价值尚未得到充分研究。对2003年4月至2004年12月纳入ADHERE的HF住院患者进行了分析。在77467次住院病例中，48629例（63%）在入院时进行了BNP评估。其中42636例（88%）进行了Tn评估。使用经年龄、性别、血尿素氮、收缩压、肌酐、钠、脉搏和静息呼吸困难校正的逻辑回归模型评估住院死亡率。BNP中位数为840 pg/ml（四分位间距430至1730）。在42636例HF病例中，2370例（5.6%）Tn升高。BNP高于中位数和Tn升高与住院死亡率风险显著增加相关（比值比[OR]分别为2.09和2.41，p值均<0.0001）。BNP≥840/Tn升高的患者死亡率为10.2%，而BNP<840/Tn未升高的患者死亡率为2.2%（OR 5.10，p<0.0001）。在进行协变量校正后，BNP≥840/Tn未升高（校正OR 1.56，95%置信区间1.40至1.79，p<0.0001）、BNP<840/Tn升高（校正OR 1.69，95%置信区间1.17至2.45，p = 0.006）和BNP≥840/Tn升高（校正OR 3.00，95%置信区间2.47至3.66，p<0.0001）时，死亡风险仍显著增加。入院时BNP和心肌Tn水平是急性失代偿性HF患者住院死亡率的重要独立预测因素。BNP水平≥840 pg/ml且Tn水平升高的患者死亡风险尤其高。总之，评估HF住院患者的多标志物策略可提供额外的预后信息。
