Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.
Int J Cardiol. 2011 Aug 4;150(3):296-300. doi: 10.1016/j.ijcard.2010.04.039. Epub 2010 May 20.
Recent evidence suggests that high adiponectin levels serve as an independent predictor of mortality in chronic heart failure (CHF) patients. We aimed to assess the prognostic importance of adiponectin in CHF towards heart failure-related hospital admissions and mortality, in relation to other clinical, laboratory and exercise data.
Seventy-three CHF patients were recruited from the Heart Failure Clinic of the Antwerp University Hospital and followed for a median of 7 (range 1.5-9.1) years. Study endpoint was the combined occurrence of heart failure-related hospitalizations and all-cause death. At baseline patients underwent clinical assessment, echocardiography and cardiopulmonary exercise testing. Circulating concentrations of adiponectin, NT-proBNP and lipoproteins were measured. After follow-up the hazard ratio (HR) of adiponectin for outcome was estimated using multivariable Cox proportional hazard regression analysis.
During follow-up, 14 (19%) patients died and 46 (63%) were admitted for CHF deterioration. The unadjusted hazard for poor outcome was higher in patients with adiponectin values above the 75th percentile (15.2mg/L) (P=0.031). Adiponectin remained independently predictive [HR (95% CI) 2.47 (1.21-5.03), P=0.013], when controlling for well-established predictors of mortality/morbidity in CHF. Additional correction for BMI, NT-proBNP, VO(2) peak, HDL and triglycerides did not affect the HR estimate. After adjusting for beta-blocker intake the association between adiponectin and poor outcome was no longer significant.
High adiponectin levels predict poor outcome in CHF patients independently of well-established and novel prognostic factors, but this prognostic value is significantly affected by beta-blocker treatment.
最近的证据表明，高水平的脂联素可作为慢性心力衰竭（CHF）患者死亡率的独立预测因子。我们旨在评估脂联素在 CHF 中的预后重要性，以了解其与心力衰竭相关的住院和死亡率的关系，并评估其他临床、实验室和运动数据。
从安特卫普大学医院的心力衰竭诊所招募了 73 名 CHF 患者，并进行了中位数为 7（范围 1.5-9.1）年的随访。研究终点是心力衰竭相关住院和全因死亡的联合发生。在基线时，患者接受了临床评估、超声心动图和心肺运动测试。测量循环脂联素、NT-proBNP 和脂蛋白的浓度。随访后，使用多变量 Cox 比例风险回归分析估计脂联素对结局的风险比（HR）。
在随访期间，14 名（19%）患者死亡，46 名（63%）因心力衰竭恶化而住院。脂联素值高于第 75 百分位（15.2mg/L）的患者不良预后的未调整 HR 更高（P=0.031）。当控制 CHF 中死亡率/发病率的既定预测因子时，脂联素仍然是独立的预测因子[HR（95%CI）2.47（1.21-5.03），P=0.013]。进一步校正 BMI、NT-proBNP、VO 2 峰值、HDL 和甘油三酯对 HR 估计值没有影响。在调整β受体阻滞剂的摄入量后，脂联素与不良预后之间的关联不再显著。
高水平的脂联素可独立于既定和新型预后因素预测 CHF 患者的不良预后，但这种预后价值受到β受体阻滞剂治疗的显著影响。
