基础 B 型利钠肽：预测房颤患者导管消融术后结局的性别特异性指标。

Baseline B-type natriuretic peptide: a gender-specific predictor of procedure-outcome in atrial fibrillation patients undergoing catheter ablation.

机构信息

St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas 78705, USA.

出版信息

J Cardiovasc Electrophysiol. 2011 Aug;22(8):858-65. doi: 10.1111/j.1540-8167.2011.02036.x. Epub 2011 Mar 3.

DOI:10.1111/j.1540-8167.2011.02036.x

PMID:21371160

Abstract

BACKGROUND

Close association between atrial fibrillation (AF) and brain natriuretic peptide (BNP) has been demonstrated by several studies. Important gender differences exist in AF patients including a higher plasma BNP level in women. Therefore, it is imperative to evaluate the relationship between AF and BNP separately in men and women.

OBJECTIVE

This study examined possible gender-specific role of BNP in predicting procedure outcome in AF patients undergoing catheter ablation.

METHOD

The study population included 568 consecutive patients (age 62 ± 10, male 73%, paroxysmal 25%, persistent 38%, and long-standing persistent AF 37%) undergoing AF ablation, who had structurally normal heart and left ventricular ejection fraction ≥45%. Baseline BNP was measured in all. Patients were grouped into "normal" and "high" BNP based on gender-specific cut-off values (<50 and ≥50 pg/mL in males, <100 and ≥ 100 pg/mL in females).

RESULT

Baseline BNP was significantly higher among women than men (126 ± 112 versus 87 ± 99, P = 0.009). At 12 ± 6 month follow-up, 304 of 414 (73%) males and 98 of 154 (64%) females were AF/atrial tachycardia-free off antiarrhythmic drugs (log-rank P = 0.018). In multivariable analysis, BNP remained an independent predictor of AF recurrence (BNP ≥ 50: hazard ratio [HR] 2.54, P = 0.006) in males. No such association was observed among females (BNP ≥ 100: HR 0.79, 95% CI 0.43-1.42; P = 0.426).

CONCLUSION

Baseline BNP was found to be an independent predictor of AF recurrence in male patients undergoing ablation. This correlation between BNP and AF recurrence was not observed in females. Thus, BNP plays a gender-specific prognostic role in AF.

摘要

背景

多项研究表明心房颤动（AF）与脑利钠肽（BNP）密切相关。在 AF 患者中存在重要的性别差异，包括女性的血浆 BNP 水平更高。因此，必须分别评估男性和女性中 AF 与 BNP 之间的关系。

目的

本研究检查了 BNP 在预测接受导管消融的 AF 患者手术结果方面的可能性别特异性作用。

方法

该研究人群包括 568 例连续患者（年龄 62 ± 10 岁，男性 73%，阵发性 25%，持续性 38%，长期持续性 AF 37%），接受 AF 消融，心脏结构正常，左心室射血分数≥45%。所有患者均检测了基线 BNP。根据性别特异性截断值（男性<50 和≥50pg/mL，女性<100 和≥100pg/mL），将患者分为“正常”和“高” BNP 组。

结果

女性的基线 BNP 明显高于男性（126±112 与 87±99，P=0.009）。在 12±6 个月的随访中，414 例男性中有 304 例（73%）和 154 例女性中有 98 例（64%）无 AF/房性心动过速且无抗心律失常药物（对数秩 P=0.018）。多变量分析显示，BNP 仍然是男性 AF 复发的独立预测因子（BNP≥50：风险比[HR]2.54，P=0.006）。但在女性中未观察到这种相关性（BNP≥100：HR 0.79，95%CI 0.43-1.42；P=0.426）。