Cournot Maxime, Mourre Fabien, Castel Fabienne, Ferrières Jean, Destrac Sylvain
Department of Cardiology, Centre Hospitalier du Val d'Ariège, Foix, France.
Am Heart J. 2008 Jun;155(6):986-91. doi: 10.1016/j.ahj.2008.01.011. Epub 2008 Mar 12.
In elderly patients hospitalized for decompensated heart failure, B-type natriuretic peptide (BNP) levels at discharge and the change in BNP during hospitalization may provide different information and may need to be taken into account simultaneously to best reflect the response to therapy. The aim of this study was to determine whether the most accurate risk stratification is obtained using BNP level after stabilization on treatment, the change in BNP under optimal treatment, or a combination of both markers.
This prospective cohort study included 157 consecutive patients aged >or=70 (mean, 83 years), hospitalized for decompensated heart failure. Clinical, radiologic, biologic, and ultrasonography data were collected on admission and at discharge.
The median BNP level on admission was 1,057 pg/mL, and the mean change during hospitalization was -42%. Cardiac death or readmission were independently predicted by both predischarge BNP (best threshold: >360 pg/mL, HR 3.35 [1.94-5.75]) and the change in BNP levels (best threshold: -50%, HR 2.52 [1.59-4.01]). The highest event rate was observed in patients with both a predischarge BNP >or=360 pg/mL and a decrease <50% during hospitalization (HR 5.97 [2.98-11.94] compared with patients with a predischarge BNP <360 pg/mL and a decrease >or=50%, after adjustment for potential confounders). The remaining patients constituted an intermediate risk group (HR 3.13 [1.44-6.77]).
Predischarge BNP and inhospital BNP change should not be interpreted independently from each other. The highest risk group includes patients with a high predischarge BNP level corresponding to more than the half of the BNP on admission. These patients would benefit from close monitoring for signs of decompensation.
在因失代偿性心力衰竭住院的老年患者中，出院时的B型利钠肽（BNP）水平以及住院期间BNP的变化可能提供不同的信息，可能需要同时考虑以最好地反映对治疗的反应。本研究的目的是确定使用治疗稳定后的BNP水平、最佳治疗下BNP的变化或两者结合是否能获得最准确的风险分层。
这项前瞻性队列研究纳入了157例年龄≥70岁（平均83岁）因失代偿性心力衰竭住院的连续患者。入院时和出院时收集了临床、放射学、生物学和超声检查数据。
入院时BNP水平中位数为1057 pg/mL，住院期间平均变化为-42%。出院前BNP（最佳阈值：>360 pg/mL，HR 3.35[1.94-5.75]）和BNP水平变化（最佳阈值：-50%，HR 2.52[1.59-4.01]）均独立预测心脏死亡或再入院。在出院前BNP≥360 pg/mL且住院期间下降<50%的患者中观察到最高事件发生率（与出院前BNP<360 pg/mL且下降≥50%的患者相比，调整潜在混杂因素后HR 5.97[2.98-11.94]）。其余患者构成中度风险组（HR 3.13[1.44-6.77]）。
出院前BNP和住院期间BNP变化不应相互独立解释。最高风险组包括出院前BNP水平高且相当于入院时BNP一半以上的患者。这些患者将受益于对失代偿迹象的密切监测。
