基于利钠肽的生活质量和慢性心力衰竭治疗：来自利钠肽指导的门诊个体化慢性心力衰竭治疗（PROTECT）研究的结果。

Quality of life and chronic heart failure therapy guided by natriuretic peptides: results from the ProBNP Outpatient Tailored Chronic Heart Failure Therapy (PROTECT) study.

机构信息

Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA.

出版信息

Am Heart J. 2012 Nov;164(5):793-799.e1. doi: 10.1016/j.ahj.2012.08.015.

DOI:10.1016/j.ahj.2012.08.015

PMID:23137512

Abstract

BACKGROUND

Heart failure (HF) treatment guided by amino-terminal pro-B type natriuretic peptide (NT-proBNP) may reduce cardiovascular event rates compared to standard-of-care (SOC) management. Comprehensive understanding regarding effect of NT-proBNP guided care on patient-reported quality of life (QOL) remains unknown.

METHODS

One hundred fifty-one subjects with HF due to left ventricular systolic dysfunction were randomized to either SOC HF management or care with a goal to reduce NT-proBNP values ≤1000 pg/mL. Effects of HF on QOL were assessed using the Minnesota Living with HF Questionnaire (MLHFQ) quarterly, with change (Δ) in score assessed across study procedures and as a function of outcome.

RESULTS

Overall, baseline MLHFQ score was 30. Across study visits, QOL improved in both arms, but was more improved and sustained in the NT-proBNP arm (repeated measures P = .01); NT-proBNP patients showing greater reduction in MLHFQ score (-10.0 vs -5.0; P = .05), particularly in the physical scale of the questionnaire. Baseline MLHFQ scores did not correlate with NT-proBNP; in contrast, ∆MLHFQ scores modestly correlated with ∆NT-proBNP values (ρ = .234; P = .006) as did relative ∆ in MLHFQ score and NT-proBNP (ρ = .253; P = .003). Considered in tertiles, less improvement in MLHFQ scores was associated with a higher rate of HF hospitalization, worsening HF, and cardiovascular death (P = .001).

CONCLUSIONS

We describe novel associations between NT-proBNP concentrations and QOL scores among patients treated with biomarker guided care. Compared to SOC HF management, NT-proBNP guided care was associated with greater and more sustained improvement in QOL (Clinical Trial Registration: www.clinicaltrials.govNCT00351390).

摘要

背景

与标准治疗（SOC）管理相比，基于氨基末端 pro-B 型利钠肽（NT-proBNP）的心力衰竭（HF）治疗可能降低心血管事件发生率。关于 NT-proBNP 指导护理对患者报告的生活质量（QOL）的影响，综合认识仍不清楚。

方法

151 名因左心室收缩功能障碍导致 HF 的患者被随机分为 SOC HF 管理或护理，目标是降低 NT-proBNP 值≤1000 pg/mL。使用明尼苏达州心力衰竭生活质量问卷（MLHFQ）每季度评估 HF 对 QOL 的影响，通过研究程序评估评分变化（Δ），并作为结局的函数。

结果

总体而言，基线 MLHFQ 评分为 30。在研究访视中，两组 QOL 均有所改善，但 NT-proBNP 组改善更明显且更持久（重复测量 P =.01）；NT-proBNP 患者 MLHFQ 评分降低更明显（-10.0 与-5.0；P =.05），尤其是在问卷的身体量表。基线 MLHFQ 评分与 NT-proBNP 不相关；相反，ΔMLHFQ 评分与ΔNT-proBNP 值中度相关（ρ =.234；P =.006），相对ΔMLHFQ 评分和 NT-proBNP 也相关（ρ =.253；P =.003）。按三分位数考虑，MLHFQ 评分改善较少与 HF 住院率、HF 恶化和心血管死亡较高相关（P =.001）。