Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA.
J Card Fail. 2012 Aug;18(8):626-34. doi: 10.1016/j.cardfail.2012.05.005. Epub 2012 Jun 19.
Elderly patients with heart failure (HF) have a worse prognosis than younger patients. We wished to study whether elders benefit from natriuretic peptide-guided HF care in this single-center study.
A total of 151 patients with HF resulting from left ventricular systolic dysfunction (LVSD) were treated with HF treatment by standard-of-care (SOC) management or guided by N-terminal pro-B type natriuretic peptide (NT-proBNP) values (with a goal to lower NT-proBNP ≤1000 pg/mL) over 10 months. The primary end point for this post-hoc analysis was total cardiovascular events in 2 age categories (<75 and ≥75 years). In those ≥75 years of age (n = 38), NT-proBNP values increased in the SOC arm (2570 to 3523 pg/mL, P = .01), but decreased in the NT-proBNP-guided arm (2664 to 1418 pg/mL, P = .001). Elderly patients treated with SOC management had the highest rate of cardiovascular events, whereas the elderly with NT-proBNP management had the lowest rate of cardiovascular events (1.76 events per patient versus 0.71 events per patient, P = .03); the adjusted logistic odds for cardiovascular events related to NT-proBNP-guided care for elders was 0.24 (P = .008), whereas in those <75 years (n = 113), the adjusted logistic odds for events following NT-proBNP-guided care was 0.61 (P = .10).
Natriuretic peptide-guided HF care was well tolerated and resulted in substantial improvement in cardiovascular event rates in elders (ClinicalTrials.Gov #00351390).
心力衰竭（HF）老年患者的预后比年轻患者差。我们希望在这项单中心研究中研究老年人是否受益于利钠肽指导的 HF 治疗。
共 151 名因左心室收缩功能障碍（LVSD）导致 HF 的患者接受 HF 治疗，标准治疗（SOC）管理或 N 末端 pro-B 型利钠肽（NT-proBNP）值指导（目标为降低 NT-proBNP≤1000pg/ml），持续 10 个月。该事后分析的主要终点是 2 个年龄组（<75 岁和≥75 岁）的总心血管事件。在≥75 岁的患者中（n=38），SOC 组的 NT-proBNP 值升高（2570 至 3523pg/ml，P=0.01），但 NT-proBNP 指导组降低（2664 至 1418pg/ml，P=0.001）。接受 SOC 管理的老年患者心血管事件发生率最高，而接受 NT-proBNP 管理的老年患者心血管事件发生率最低（1.76 例/患者与 0.71 例/患者，P=0.03）；与 NT-proBNP 指导的老年患者心血管事件相关的调整后逻辑概率比为 0.24（P=0.008），而<75 岁的患者（n=113），NT-proBNP 指导后事件的调整后逻辑概率比为 0.61（P=0.10）。
利钠肽指导的 HF 治疗耐受性良好，可显著降低老年患者心血管事件发生率（ClinicalTrials.Gov #00351390）。
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