Department of Cardiovascular Medicine and Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Eur J Heart Fail. 2012 Apr;14(4):367-76. doi: 10.1093/eurjhf/hfs001. Epub 2012 Jan 31.
Heart failure with preserved ejection fraction (HFpEF) is characterized by multiple co-morbidities, including chronic kidney disease that is one of the prognostic risks for these patients. This study was performed to evaluate the value of determination of albuminuria using a urine dipstick test (UDT), combined with estimated glomerular filtration rate (eGFR), for predicition of mortality in HFpEF.
We enrolled 2465 consecutive patients with overt HF with EF ≥50% in our Chronic Heart Failure Analysis and Registry in the Tohoku District 2 (CHART-2) study (NCT00418041). We defined trace or more UDT as positive. We divided the patients into the following four groups based on eGFR and UDT; group 1 (G1) (eGFR ≥60, negative UDT), G2 (eGFR ≥60, positive UDT), G3 (eGFR <60, negative UDT), and G4 (eGFR <60, positive UDT). In total, 29.5% of the HFpEF patients had a positive UDT. HFpEF patients with a positive UDT were characterized by higher brain natriuretic peptide levels and frequent histories of hypertension or diabetes. During a mean follow-up of 2.5 years, HFpEF patients with a positive UDT showed higher mortality in each stratum of eGFR levels. A multivariable adjusted Cox model showed that when compared with G1 (reference), the hazard ratio of all-cause death for G2, G3, and G4 was 2.44 (95% confidence interval 1.47-4.05, P=0.001), 1.43 (0.92-2.23, P=0.12), and 2.71 (1.72-4.27, P<0.001), respectively. Furthermore, the prognostic value of a positive UDT was robust for both cardiovascular and non-cardiovascular deaths.
These results indicate that measurement of albuminuria in addition to eGFR is useful for appropriate risk stratification in HFpEF patients.
射血分数保留的心力衰竭（HFpEF）的特征是多种合并症，包括慢性肾脏病，这是这些患者的预后风险之一。本研究旨在评估使用尿试纸检测（UDT）联合估计肾小球滤过率（eGFR）来确定蛋白尿对 HFpEF 患者死亡率的预测价值。
我们在慢性心力衰竭分析和东北 2 区登记研究（CHART-2）中纳入了 2465 例 EF≥50%的显性 HFpEF 连续患者（NCT00418041）。我们将 UDT 阳性定义为痕量或以上。根据 eGFR 和 UDT，我们将患者分为以下四组：第 1 组（G1）（eGFR≥60，UDT 阴性）、G2（eGFR≥60，UDT 阳性）、G3（eGFR<60，UDT 阴性）和 G4（eGFR<60，UDT 阳性）。HFpEF 患者中，阳性 UDT 的比例为 29.5%。UDT 阳性的 HFpEF 患者具有更高的脑利钠肽水平和更频繁的高血压或糖尿病病史。在平均 2.5 年的随访期间，UDT 阳性的 HFpEF 患者在各 eGFR 水平分层中死亡率均较高。多变量调整 Cox 模型显示，与 G1（参考）相比，G2、G3 和 G4 的全因死亡风险比分别为 2.44（95%置信区间 1.47-4.05，P=0.001）、1.43（0.92-2.23，P=0.12）和 2.71（1.72-4.27，P<0.001）。此外，UDT 阳性的预后价值对于心血管和非心血管死亡均具有稳健性。
这些结果表明，除了 eGFR 外，测量蛋白尿对 HFpEF 患者的适当风险分层很有用。
