De Vecchis R, Esposito C, Di Biase G, Ariano C
Cardiology Unit, Presidio Sanitario Intermedi, "Elena d'Aosta", Naples, Italy -
Minerva Cardioangiol. 2013 Aug;61(4):437-49.
It is not known whether therapy assisted by determinations of serum B-type natriuretic peptide (BNP) may improve the outcome for outpatients with chronic heart failure (CHF).
A retrospective case-control study was carried out, enrolling patients with acutely decompensated heart failure (ADHF) who were followed up for a mean period of four months. The patients who had died or had new episodes of ADHF were studied as the cases. For each case, one living patient who was free from ADHF-related re-hospitalisations was recruited as control. Cases and controls were also matched for some variables to minimise possible confounding. The possible role of BNP-guided therapy as a predictor of decreased risk of deaths or new hospitalisations related to heart failure was explored.
Twenty-eight cases and 44 controls were enrolled. A fall in BNP on the fifth day after admission was found to be a predictor of a decreased risk of the composite endpoint "death or new hospitalisation, heart failure-related" (hazard ratio=0.1508; 95% CI: 0.049 to 0.463; P=0.001). On the other hand, low glomerular filtration rate at admission (<60 mL/min/1.73 m2) was associated with increased risk of the abovementioned endpoint (hazard ratio=7.1785; 95% CI: 1.574 to 32.725; P=0.0113). On the contrary, BNP-guided therapy was associated with a similar risk of death and/or CHF-related hospitalisation, compared to the conventional clinical approach.
A fall in BNP ≥60% from baseline on the fifth day after admission was found to be associated with a favorable clinical outcome in outpatients with CHF after four months of follow-up, irrespective whether this finding had been detected in patients treated according to the BNP-guided therapy or in patients treated with conventional clinical criteria. However, among the outpatients with previous ADHF, a substantial improvement in cardiovascular event rates could not be demonstrated in those treated with BNP-guided therapy compared with those undergoing usual, symptom-guided treatment.
目前尚不清楚血清B型利钠肽（BNP）测定辅助治疗是否能改善慢性心力衰竭（CHF）门诊患者的预后。
进行了一项回顾性病例对照研究，纳入急性失代偿性心力衰竭（ADHF）患者，平均随访4个月。将死亡或发生新的ADHF发作的患者作为病例进行研究。对于每个病例，招募一名未因ADHF再次住院的存活患者作为对照。病例和对照还在一些变量上进行匹配，以尽量减少可能的混杂因素。探讨了BNP指导治疗作为降低心力衰竭相关死亡或新住院风险预测指标的可能作用。
共纳入28例病例和44例对照。发现入院后第5天BNP下降是复合终点“心力衰竭相关死亡或新住院”风险降低的预测指标（风险比=0.1508；95%置信区间：0.049至0.463；P=0.001）。另一方面，入院时肾小球滤过率低（<60 mL/min/1.73 m2）与上述终点风险增加相关（风险比=7.1785；95%置信区间：1.574至32.725；P=0.0113）。相反，与传统临床方法相比，BNP指导治疗与死亡和/或CHF相关住院的风险相似。
发现入院后第5天BNP较基线下降≥60%与CHF门诊患者随访4个月后的良好临床结局相关，无论该发现是在接受BNP指导治疗的患者还是接受传统临床标准治疗的患者中检测到。然而在既往有ADHF的门诊患者中，与接受常规症状指导治疗的患者相比，接受BNP指导治疗的患者心血管事件发生率并未显示出显著改善。
