应用氨基末端脑利钠肽前体指导慢性左心室收缩功能障碍患者的门诊治疗。
Use of amino-terminal pro-B-type natriuretic peptide to guide outpatient therapy of patients with chronic left ventricular systolic dysfunction.
机构信息
Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
出版信息
J Am Coll Cardiol. 2011 Oct 25;58(18):1881-9. doi: 10.1016/j.jacc.2011.03.072.
OBJECTIVES
The aim of this study was to evaluate whether chronic heart failure (HF) therapy guided by concentrations of amino-terminal pro-B-type natriuretic peptide (NT-proBNP) is superior to standard of care (SOC) management.
BACKGROUND
It is unclear whether standard HF treatment plus a goal of reducing NT-proBNP concentrations improves outcomes compared with standard management alone.
METHODS
In a prospective single-center trial, 151 subjects with HF due to left ventricular (LV) systolic dysfunction were randomized to receive either standard HF care plus a goal to reduce NT-proBNP concentrations ≤1,000 pg/ml or SOC management. The primary endpoint was total cardiovascular events between groups compared using generalized estimating equations. Secondary endpoints included effects of NT-proBNP-guided care on patient quality of life as well as cardiac structure and function, assessed with echocardiography.
RESULTS
Through a mean follow-up period of 10 ± 3 months, a significant reduction in the primary endpoint of total cardiovascular events was seen in the NT-proBNP arm compared with SOC (58 events vs. 100 events, p = 0.009; logistic odds for events 0.44, p = 0.02); Kaplan-Meier curves demonstrated significant differences in time to first event, favoring NT-proBNP-guided care (p = 0.03). No age interaction was found, with elderly patients benefitting similarly from NT-proBNP-guided care as younger subjects. Compared with SOC, NT-proBNP-guided patients had greater improvements in quality of life, demonstrated greater relative improvements in LV ejection fraction, and had more significant improvements in both LV end-systolic and -diastolic volume indexes.
CONCLUSIONS
In patients with HF due to LV systolic dysfunction, NT-proBNP-guided therapy was superior to SOC, with reduced event rates, improved quality of life, and favorable effects on cardiac remodeling. (Use of NT-proBNP Testing to Guide Heart Failure Therapy in the Outpatient Setting; NCT00351390).
目的
本研究旨在评估慢性心力衰竭（HF）治疗是否优于标准治疗（SOC）管理。
背景
目前尚不清楚与单独标准管理相比，标准 HF 治疗加降低氨基末端 pro-B 型利钠肽（NT-proBNP）浓度的目标是否能改善结局。
方法
在一项前瞻性单中心试验中，151 名因左心室（LV）收缩功能障碍导致 HF 的患者被随机分为接受标准 HF 治疗加降低 NT-proBNP 浓度至≤1000pg/ml 的目标或 SOC 治疗。使用广义估计方程比较两组之间的主要终点——总心血管事件。次要终点包括 NT-proBNP 指导的护理对患者生活质量以及心脏结构和功能的影响，通过超声心动图进行评估。
结果
在平均 10±3 个月的随访期间，与 SOC 相比，NT-proBNP 组主要终点（总心血管事件）显著降低（58 例事件 vs. 100 例事件，p=0.009；事件发生的逻辑优势比为 0.44，p=0.02）；Kaplan-Meier 曲线显示首次事件时间有显著差异，NT-proBNP 指导的护理更有利（p=0.03）。未发现年龄的交互作用，老年患者与年轻患者一样从 NT-proBNP 指导的护理中获益。与 SOC 相比，NT-proBNP 指导的患者生活质量有更大的改善，LV 射血分数的相对改善更大，LV 收缩末期和舒张末期容积指数的改善更明显。
结论
在因 LV 收缩功能障碍导致 HF 的患者中，与 SOC 相比，NT-proBNP 指导的治疗降低了事件发生率，改善了生活质量，并对心脏重构有有利影响。（使用 NT-proBNP 检测指导门诊 HF 治疗；NCT00351390）。
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