Cardiovascular Diseases Unit 2, Santa Chiara Hospital, Pisa, Italy.
Clin Cardiol. 2009 Dec;32(12):711-7. doi: 10.1002/clc.20617.
The prognostic role of echocardiography is well established in patients with previous or current symptoms of heart failure (HF). Less is understood about patients with stage B HF, who have structural heart disease but no symptoms at any stage. This study investigated the role of plasma N-terminal protype-B natriuretic peptide (NT-proBNP) and Doppler-echo parameters of diastolic and systolic function for risk stratification in stage B HF patients.
We investigated whether plasma NT-proBNP and Doppler-echo parameters of diastolic and systolic function have a role in risk stratification of stage B HF patients.
Doppler echocardiography was performed in 155 outpatients with asymptomatic left ventricular (LV) dysfunction (ejection fraction [EF] < 50%) and comprised conventional diastolic variables, including pulsed-Doppler mitral E-wave deceleration time (EDT). Plasma NT-proBNP was assessed at the time of the echocardiogram. The prespecified end point was cardiac death or HF hospitalization or any new HF episode requiring a change in medication.
Mean EF was 35% +/- 7%. Median NT-proBNP was 745 pg/mL (interquartile range [IQR], 442-1672). Patients with events at follow-up (n = 46) had higher prevalence of risk factors for developing HF. Plasma NT-proBNP, EDT, and EF were independently associated with cardiac events at multivariable analysis and receiver operating characteristic curves were used to determine the optimal prognostic cut points for each: NT-proBNP > or = 831 pg/mL, EDT < 145 msec, and EF < 37%. When used in combination, event-free survival was incrementally worse with each additional abnormality.
Plasma NT-proBNP, EDT, and EF are independently useful for prognostic stratification of stage B HF patients and suggest an incremental prognostic deficit is associated with the combination of each. This study supports the complementary role of comprehensive echocardiography and natriuretic peptide assay in asymptomatic LV dysfunction.
超声心动图在有既往或现患心力衰竭（HF）症状的患者中的预后作用已得到充分证实。对于处于心力衰竭 B 期的患者，其了解较少，这些患者有结构性心脏病，但在任何阶段都没有症状。本研究调查了血浆 N 末端脑钠肽前体（NT-proBNP）和舒张及收缩功能的多普勒超声参数在心力衰竭 B 期患者风险分层中的作用。
我们研究了血浆 NT-proBNP 和舒张及收缩功能的多普勒超声参数在心力衰竭 B 期患者风险分层中的作用。
对 155 名无症状左心室（LV）功能障碍（射血分数[EF] < 50%）的门诊患者进行了多普勒超声心动图检查，包括脉冲多普勒二尖瓣 E 波减速时间（EDT）等常规舒张变量。在进行超声心动图检查时评估了血浆 NT-proBNP。预设终点是心脏死亡或 HF 住院或任何需要改变药物治疗的新 HF 发作。
平均 EF 为 35% +/- 7%。中位数 NT-proBNP 为 745 pg/mL（四分位距[IQR]，442-1672）。在随访期间发生事件的患者（n = 46）具有更多 HF 发展的危险因素。多变量分析显示，血浆 NT-proBNP、EDT 和 EF 与心脏事件独立相关，ROC 曲线用于确定每种变量的最佳预后截断值：NT-proBNP > = 831 pg/mL、EDT < 145 msec 和 EF < 37%。当联合使用时，随着每个异常的增加，无事件生存率逐渐恶化。
血浆 NT-proBNP、EDT 和 EF 对心力衰竭 B 期患者的预后分层均有独立的作用，提示每种异常的组合与预后缺陷的递增相关。本研究支持综合超声心动图和利钠肽检测在无症状 LV 功能障碍中的互补作用。
