Felker G Michael, Whellan David, Kraus William E, Clare Robert, Zannad Faiez, Donahue Mark, Adams Kirkwood, McKelvie Robert, Piña Ileana L, O'Connor Christopher M
Duke Clinical Research Institute, Durham, NC 27705, USA.
Am Heart J. 2009 Oct;158(4 Suppl):S37-44. doi: 10.1016/j.ahj.2009.07.011.
To examine the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) and exercise capacity in a large contemporary cohort of patients with chronic heart failure.
Natriuretic peptides such as NT-proBNP are important biomarkers in heart failure. The relationship between NT-proBNP and exercise capacity has not been well studied.
We analyzed the relationship between baseline NT-proBNP and peak oxygen uptake (peak VO(2)) or distance in the 6-minute walk test in 1383 subjects enrolled in the HF-ACTION study. Linear regression models were used to analyze the relationship between NT-proBNP and peak Vo(2) or distance in the 6-minute walk test in the context of other clinical variables. Receiver operator curve analysis was used to evaluate the ability of NT-proBNP to accurately predict a peak VO(2) <12 mL/kg per minute.
NT-proBNP was the most powerful predictor of peak VO(2) (partial R(2) = 0.13, P < .0001) of 35 candidate variables. Although NT-proBNP was also a predictor of distance in the 6-minute walk test, this relationship was weaker than that for peak VO(2) (partial R(2) = 0.02, P < .0001). For both peak VO(2) and distance in the 6-minute walk test, much of the variability in exercise capacity remained unexplained by the variables tested. Receiver operator curve analysis suggested NT-proBNP had moderate ability to identify patients with peak VO(2) <12 mL/kg per minute (c-index, 0.69).
In this analysis of baseline data from HF-ACTION, NT-proBNP was the strongest predictor of peak VO(2) and a significant predictor of distance in the 6-minute walk test. Despite these associations, NT-proBNP demonstrated only modest performance in identifying patients with a low peak VO(2) who might be considered for cardiac transplantation. These data suggest that, although hemodynamic factors are important determinants of exercise capacity, much of the variability in exercise performance in heart failure remains unexplained by traditional clinical and demographic variables.
在当代一大群慢性心力衰竭患者中研究N末端脑钠肽前体（NT-proBNP）与运动能力之间的关系。
诸如NT-proBNP之类的利钠肽是心力衰竭中的重要生物标志物。NT-proBNP与运动能力之间的关系尚未得到充分研究。
我们分析了参加HF-ACTION研究的1383名受试者的基线NT-proBNP与峰值摄氧量（峰值VO₂）或6分钟步行试验中的距离之间的关系。线性回归模型用于分析在其他临床变量背景下NT-proBNP与峰值VO₂或6分钟步行试验中的距离之间的关系。采用受试者工作特征曲线分析来评估NT-proBNP准确预测峰值VO₂<12 mL/（kg·分钟）的能力。
在35个候选变量中，NT-proBNP是峰值VO₂的最有力预测指标（偏R² = 0.13，P <.0001）。尽管NT-proBNP也是6分钟步行试验中距离的预测指标，但这种关系比峰值VO₂的关系弱（偏R² = 0.02，P <.0001）。对于峰值VO₂和6分钟步行试验中的距离，运动能力的许多变异性仍无法通过所测试的变量来解释。受试者工作特征曲线分析表明，NT-proBNP具有中等能力来识别峰值VO₂<12 mL/（kg·分钟）的患者（c指数，0.69）。
在对HF-ACTION基线数据的这项分析中，NT-proBNP是峰值VO₂的最强预测指标，也是6分钟步行试验中距离的重要预测指标。尽管存在这些关联，但NT-proBNP在识别可能考虑进行心脏移植的低峰值VO₂患者方面仅表现出适度的性能。这些数据表明，尽管血流动力学因素是运动能力的重要决定因素，但心力衰竭患者运动表现的许多变异性仍无法通过传统的临床和人口统计学变量来解释。
