Tsutamoto Takayoshi, Nishiyama Keizo, Sakai Hiroshi, Tanaka Toshinari, Fujii Masanori, Yamamoto Takashi, Yamaji Masayuki, Horie Minoru
Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu 520-2192, Japan.
Eur J Heart Fail. 2008 Dec;10(12):1208-14. doi: 10.1016/j.ejheart.2008.09.011. Epub 2008 Nov 1.
No previous study has compared the transcardiac gradient of norepinephrine (NE) and the prognosis of patients with chronic heart failure (CHF).
To evaluate the prognostic role of the transcardiac gradient of NE in patients with CHF.
We measured haemodynamic parameters and plasma levels of NE, brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in the aortic root (AO) and coronary sinus (CS) in 356 consecutive patients with CHF.
During a median follow-up of 3.5 years, 40 patients died. Transcardiac gradients of BNP (273+/-276 vs. 472+/-433 pg/mL, p<0.0001), NT-proBNP (417+/-700 vs. 928+/-1093 pg/mL, p<0.0001) and NE (114+/-160 vs. 473+/-992 pg/mL, p<0.0001) were significantly higher in non-survivors than survivors. After adjustment for clinical variables associated with CHF including haemodynamics and neurohumoral factors, the transcardiac gradient of NE (p<0.0001) and plasma log NT-proBNP (p<0.0001) were independent prognostic predictors. Among 67 patients in whom 123I-metaiodobenzylguanidine (MIBG) could be performed, transcardiac increase in NE was correlated with the washout rate (r=0.398, p=0.0009) and was a superior predictor of mortality than MIBG parameters on stepwise multivariable Cox proportional hazards regression analyses.
The transcardiac increase in NE is an independent and useful prognostic predictor for evaluating the prognosis of CHF patients.
既往尚无研究比较去甲肾上腺素（NE）的跨心脏梯度与慢性心力衰竭（CHF）患者的预后。
评估NE跨心脏梯度在CHF患者中的预后作用。
我们对356例连续性CHF患者的主动脉根部（AO）和冠状窦（CS）进行血流动力学参数以及血浆NE、脑钠肽（BNP）和N末端脑钠肽原（NT-proBNP）水平的测定。
在中位随访3.5年期间，40例患者死亡。非存活者的BNP跨心脏梯度（273±276 vs. 472±433 pg/mL，p<0.0001）、NT-proBNP（417±700 vs. 928±1093 pg/mL，p<0.0001）和NE（114±160 vs. 473±992 pg/mL，p<0.0001）显著高于存活者。在对包括血流动力学和神经体液因素在内的与CHF相关的临床变量进行校正后，NE的跨心脏梯度（p<0.0001）和血浆log NT-proBNP（p<0.0001）是独立的预后预测指标。在67例可进行123I-间碘苄胍（MIBG）检查的患者中，NE的跨心脏升高与洗脱率相关（r=0.398，p=0.0009），并且在逐步多变量Cox比例风险回归分析中，NE跨心脏升高比MIBG参数更能预测死亡率。
NE的跨心脏升高是评估CHF患者预后的一个独立且有用的预后预测指标。
