A 期或 B 期心力衰竭伴有 B 型利钠肽水平升高患者的预后。

Prognosis of stage A or B heart failure patients with elevated B-type natriuretic peptide levels.

机构信息

Division of Cardiology, Department of Medicine, University of California at San Diego, San Diego, CA, USA.

出版信息

J Card Fail. 2010 Feb;16(2):93-8. doi: 10.1016/j.cardfail.2009.10.020. Epub 2009 Nov 14.

DOI:10.1016/j.cardfail.2009.10.020

PMID:20142019

Abstract

BACKGROUND

Heart failure (HF) patients have a poor prognosis, yet outcomes might be improved by early identification of risk. We investigated the prognostic value of B-type natriuretic peptide (BNP) in patients at risk for HF (American College of Cardiology [ACC]/American Heart Association [AHA] HF Stages A and B), and compared prognosis with Stage C/D patients.

METHODS AND RESULTS

Outpatients referred for echocardiogram (n=829) were stratified by ACC/AHA HF stage and BNP levels (cutpoint of 100pg/mL). Primary outcome was death or cardiac hospitalization at 1 year. BNP levels increased with increasing numbers of cardiovascular risk factors and with HF stage. Stage A/B patients with high BNP had a similar or worse prognosis than Stage C/D patients with low BNP. In fact, the prognosis of Stage C/D patients with low BNP did not significantly differ from the prognosis of Stage A/B patients with low BNP (adjusted HR 1.21, 95% CI 0.62-2.37), whereas Stage A/B patients with high BNP did have a significantly worse prognosis (adjusted HR 1.91, 95% CI 1.11-3.28).

CONCLUSIONS

Individuals without any history of HF but with BNP >or=100pg/mL are at equal or higher risk than those with a HF history whose BNP is <100pg/mL. BNP may be useful to identify asymptomatic individuals at high risk for future cardiovascular events.

摘要

背景

心力衰竭（HF）患者预后较差，但通过早期识别风险，可能会改善预后。我们研究了 B 型利钠肽（BNP）在有心力衰竭风险的患者（美国心脏病学会 [ACC]/美国心脏协会 [AHA] HF 分期 A 和 B）中的预后价值，并与 C/D 期患者的预后进行了比较。

方法和结果

因超声心动图就诊的门诊患者（n=829）根据 ACC/AHA HF 分期和 BNP 水平（截定点 100pg/mL）进行分层。主要终点为 1 年内死亡或心脏住院。随着心血管危险因素数量的增加和 HF 分期的增加，BNP 水平升高。高 BNP 的 A/B 期患者的预后与低 BNP 的 C/D 期患者相似或更差。事实上，低 BNP 的 C/D 期患者的预后与低 BNP 的 A/B 期患者的预后无显著差异（调整后的 HR 1.21，95%CI 0.62-2.37），而高 BNP 的 A/B 期患者的预后显著更差（调整后的 HR 1.91，95%CI 1.11-3.28）。