Dini Frank Lloyd, Conti Umberto, Fontanive Paolo, Andreini Diana, Panicucci Erica, De Tommasi Salvatore Mario
Unità Malattie Cardiovascolari 2, Santa Chiara Hospital, Italy.
Am J Cardiol. 2008 Aug 15;102(4):463-8. doi: 10.1016/j.amjcard.2008.03.083. Epub 2008 May 24.
Prognostication of patients with chronic heart failure (HF) stabilized by therapy may be difficult. Therefore, the aim was to evaluate whether combined assessment of plasma N-terminal pro-B natriuretic peptide (NT-pro-BNP) and Doppler left ventricular (LV) diastolic variables was relevant to the prognosis of patients with stable HF. Outpatients with LV systolic HF (ejection fraction < or =45%), classified using clinical criteria as decompensated (n = 94) and stable HF (n = 219), underwent a complete Doppler echocardiographic study. NT-pro-BNP was measured together with mitral wave velocities, E wave deceleration time, and tissue Doppler early septal annular velocity. Median follow-up was 22 months. Freedom from all-cause mortality or HF hospitalization at 24 months was worst (44%) in patients with decompensated HF, intermediate (58%) in patients with stable HF with NT-pro-BNP higher than the median (>1,129 pg/ml), and best (92%) in patients with lower NT-pro-BNP (log-rank p <0.0001). In patients with stable HF, NT-pro-BNP >1,129 pg/ml (hazard ratio [HR] 2.84, p = 0.003), E wave deceleration time <150 ms (HR 2.31, p = 0.004), and tissue Doppler early septal annular velocity <8 cm/s (HR 2.18, p = 0.01) were predictors of the end point at multivariate analysis. The addition of Doppler LV diastolic variables and NT-pro-BNP significantly improved the chi-square test for outcome prediction (from 14.4 to 46.4). In conclusion, NT-pro-BNP and spectral and tissue Doppler variables of LV diastolic dysfunction added independent and incremental contributions to prognostic stratification of patients with stable HF.
对经治疗病情稳定的慢性心力衰竭（HF）患者进行预后评估可能具有挑战性。因此，本研究旨在评估血浆N末端B型利钠肽原（NT-pro-BNP）与多普勒左心室（LV）舒张期变量的联合评估是否与稳定型HF患者的预后相关。根据临床标准分类为失代偿性（n = 94）和稳定型HF（n = 219）的左心室收缩性HF（射血分数≤45%）门诊患者接受了完整的多普勒超声心动图检查。同时测量NT-pro-BNP以及二尖瓣血流速度、E波减速时间和组织多普勒早期室间隔环速度。中位随访时间为22个月。在24个月时，失代偿性HF患者的全因死亡率或HF住院率最低（44%），NT-pro-BNP高于中位数（>1129 pg/ml）的稳定型HF患者为中等（58%），而NT-pro-BNP较低的患者最佳（92%）（对数秩检验p<0.0001）。在稳定型HF患者中，NT-pro-BNP>1129 pg/ml（风险比[HR] 2.84，p = 0.003）、E波减速时间<150 ms（HR 2.31，p = 0.004）和组织多普勒早期室间隔环速度<8 cm/s（HR 2.18，p = 0.01）在多变量分析中是终点事件的预测因素。添加多普勒左心室舒张期变量和NT-pro-BNP显著改善了结局预测的卡方检验（从14.4提高到46.4）。总之，NT-pro-BNP以及左心室舒张功能障碍的频谱和组织多普勒变量为稳定型HF患者的预后分层增加了独立且递增的贡献。
