Institute of Cardiovascular Science, The Heart Hospital, University College London, 16-18 Westmoreland Street, London W1G 8PH, UK.
Eur Heart J. 2013 Aug;34(32):2529-37. doi: 10.1093/eurheartj/eht070. Epub 2013 Mar 1.
To determine the relation between serum concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) and prognosis in patients with hypertrophic cardiomyopathy (HCM).
In total, 847 patients (53 ± 15 years; 67% male) with HCM (28% with left ventricular outflow tract obstruction ≥ 30 mmHg at rest) were followed for 3.5 years (IQR 2.5-4.5 years). The median NT-proBNP concentration was 78 pmol/L (range < 5-1817 pmol/L and IQR 31-183 pmol/L). Sixty-eight patients (8%) reached the primary endpoint of all-cause mortality or cardiac transplantation. NT-proBNP concentration predicted long-term survival from the primary endpoint [area under the receiver operating characteristic curve of 0.78 (95% confidence interval 0.73-0.84)]. A serum concentration of ≥ 135 pmol/L was associated with an annual event rate of 6.1% (95% CI 4.4-7.7). Three independent predictors of primary outcome were identified in a multivariable Cox model: New York Heart Association class III/IV (HR 2.10, 95% CI 1.21-3.65, P = 0.008), ejection fraction (HR 0.98, 95% CI 0.96-1.00, P = 0.035), log NT-proBNP (HR 2.04, 95% CI 1.56-2.66, P < 0.001). Log NT-proBNP was a significant predictor of heart failure (HF) and transplant-related deaths (n = 23; HR 3.03, 95% CI 1.99-4.60, P < 0.001) but not sudden death or appropriate implantable cardioverter defibrillator shock (n = 11; HR 1.54, 95% CI 0.91-2.60, P = 0.111). In patients with ejection fraction ≥ 50% (n = 673), log NT-proBNP remained an independent predictor of the primary outcome (HR 2.11, 95% CI 1.54-2.90, P < 0.001).
In patients with HCM, elevated NT-proBNP concentration is a strong predictor of overall prognosis, particularly HF-related death and transplantation.
确定肥厚型心肌病（HCM）患者血清 N 端脑利钠肽前体（NT-proBNP）浓度与预后的关系。
共纳入 847 例 HCM 患者（53 ± 15 岁；67%为男性），随访 3.5 年（IQR 2.5-4.5 年）。中位 NT-proBNP 浓度为 78 pmol/L（范围 < 5-1817 pmol/L，IQR 31-183 pmol/L）。68 例（8%）患者达到全因死亡或心脏移植的主要终点。NT-proBNP 浓度可预测主要终点的长期生存率[受试者工作特征曲线下面积为 0.78（95%置信区间 0.73-0.84）]。血清浓度≥135 pmol/L与每年 6.1%的事件发生率相关（95%CI 4.4-7.7）。多变量 Cox 模型确定了主要结局的 3 个独立预测因素：纽约心脏协会（NYHA）心功能分级 III/IV 级（HR 2.10，95%CI 1.21-3.65，P = 0.008）、射血分数（HR 0.98，95%CI 0.96-1.00，P = 0.035）、log NT-proBNP（HR 2.04，95%CI 1.56-2.66，P < 0.001）。log NT-proBNP 是心力衰竭（HF）和移植相关死亡（n = 23；HR 3.03，95%CI 1.99-4.60，P < 0.001）的显著预测因素，但不是猝死或适当的植入式心脏复律除颤器电击（n = 11；HR 1.54，95%CI 0.91-2.60，P = 0.111）。在射血分数≥50%的患者（n = 673）中，log NT-proBNP 仍然是主要结局的独立预测因素（HR 2.11，95%CI 1.54-2.90，P < 0.001）。
在 HCM 患者中，升高的 NT-proBNP 浓度是整体预后的有力预测指标，尤其是与 HF 相关的死亡和移植。
