McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
J Card Fail. 2010 Feb;16(2):128-34. doi: 10.1016/j.cardfail.2009.09.007. Epub 2009 Nov 4.
N-terminal B type natriuretic peptide (NT-proBNP) is usually elevated in heart failure (HF) patients with reduced ejection fraction (EF). Less is known about NT-proBNP in HF with preserved EF (HF-PEF). We measured baseline NT-proBNP in 3562 HF-PEF enrolled patients in the Irbesartan in Heart Failure with Preserved Ejection Fraction trial.
Patients with EF >or=45%, age >or=60 years, and either New York Heart Association (NYHA) II-IV symptoms with HF hospitalization (HFH) within 6 months or NYHA III-IV symptoms with corroborative evidence of HF or structural changes associated with HF-PEF. NT-proBNP (pg/mL) measured centrally using the Elecsys proBNP assay (Roche). Mean age 72 +/- 7 years, 60% were women, the investigator indicated HF etiology was hypertension in 64%; the majority were in NYHA III. Medications included diuretics in 82%, angiotensin-converting enzyme inhibitor in 26%, beta-blocker in 59%, and spironolactone in 15%. Median NT-proBNP was 341 pg/mL (interquartile range 135 to 974 pg/mL) and geometric mean was 354 pg/mL. In multivariate analysis, the baseline characteristics most strongly associated with higher NT-proBNP levels were atrial fibrillation (ratio of geometric mean 2.59, P < .001), NYHA IV symptoms (1.52, P < .001), lower estimated glomerular filtration rate (1.44, P < .001), and HFH hospitalization within 6 months (1.37, P < .001).
Most HF-PEF patients have elevated NT-proBNP levels. The NT-proBNP concentrations were related to baseline characteristics generally associated with worse outcomes for HF patients.
N 端脑利钠肽前体（NT-proBNP）在射血分数降低的心力衰竭（HF）患者中通常升高。在射血分数保留的心力衰竭（HF-PEF）患者中，NT-proBNP 的情况知之甚少。我们在 Irbesartan in Heart Failure with Preserved Ejection Fraction 试验中测量了 3562 名 HF-PEF 入选患者的基线 NT-proBNP。
入选患者的射血分数>或=45%，年龄>或=60 岁，并且具有以下任一情况：HF 住院（HFH）发生在 6 个月内的纽约心脏协会（NYHA）II-IV 级症状；或 NYHA III-IV 级症状伴 HF 或与 HF-PEF 相关的结构性改变的明确证据。使用 Elecsys proBNP 检测（罗氏）对中心 NT-proBNP（pg/mL）进行测量。平均年龄为 72+/-7 岁，60%为女性，研究者指出 HF 病因是高血压（64%）；大多数患者 NYHA 分级为 III 级。使用的药物包括利尿剂（82%）、血管紧张素转换酶抑制剂（26%）、β受体阻滞剂（59%）和螺内酯（15%）。中位 NT-proBNP 为 341pg/mL（四分位距 135 至 974pg/mL），几何均数为 354pg/mL。多变量分析显示，与较高 NT-proBNP 水平最密切相关的基线特征是心房颤动（几何均数比 2.59，P<0.001）、NYHA IV 级症状（1.52，P<0.001）、估算肾小球滤过率较低（1.44，P<0.001）和 6 个月内 HFH 住院（1.37，P<0.001）。
大多数 HF-PEF 患者的 NT-proBNP 水平升高。NT-proBNP 浓度与一般与 HF 患者预后不良相关的基线特征有关。
