Vorovich Esther, French Benjamin, Ky Bonnie, Goldberg Lee, Fang James C, Sweitzer Nancy K, Cappola Thomas P
Penn Cardiovascular Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Penn Cardiovascular Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
J Card Fail. 2014 Aug;20(8):569-76. doi: 10.1016/j.cardfail.2014.05.013. Epub 2014 Jun 11.
Identification of heart failure (HF) patients at risk for hospitalization may improve care and reduce costs. We evaluated 9 biomarkers as predictors of cardiac hospitalization in chronic HF.
In a multicenter cohort of 1,512 chronic HF outpatients, we assessed the association between 9 biomarkers and cardiac hospitalization with the use of a recurrent events approach. Over a median follow-up of 4 years, 843 participants experienced ≥ 1 hospitalizations (total 2,178 hospitalizations). B-type natriuretic peptide (BNP) and troponin I (TnI) exhibited the strongest associations with risk of hospitalization (hazard ratio [HR] 3.8 [95% confidence interval (CI) 2.9-4.9] and HR 3.3 [95% CI 2.8-3.9]; 3rd vs 1st tertiles). Soluble Fms-like tyrosine kinase receptor 1 (sFlt-1) exhibited the next strongest association (HR 2.8 [95% CI 2.4-3.4]), followed by soluble Toll-like receptor 2 (HR 2.3 [95% CI 2.0-2.8]) and creatinine (HR 1.9 [95% CI 1.6-2.4]). Within ischemic/nonischemic subgroups, BNP and TnI remained most strongly associated. Except for creatinine, HRs for all biomarkers studied were smaller within the ischemic subgroup, suggesting greater importance of cardiorenal interactions in decompensation of ischemic HF.
Although BNP and TnI exhibited the strongest associations with hospitalization, etiology-dependent associations for the remaining biomarkers suggest etiology-specific mechanisms for HF exacerbation. sFlt-1 exhibited a strong association with cardiac hospitalization, highlighting its potential role as a biomarker of HF morbidity.
识别有住院风险的心力衰竭（HF）患者可能会改善治疗并降低成本。我们评估了9种生物标志物作为慢性HF患者心脏住院的预测指标。
在一个由1512名慢性HF门诊患者组成的多中心队列中，我们采用复发事件方法评估了9种生物标志物与心脏住院之间的关联。在中位随访4年期间，843名参与者经历了≥1次住院（共2178次住院）。B型利钠肽（BNP）和肌钙蛋白I（TnI）与住院风险的关联最强（风险比[HR] 3.8 [95%置信区间（CI）2.9 - 4.9]和HR 3.3 [95% CI 2.8 - 3.9]；第三分位数与第一分位数相比）。可溶性Fms样酪氨酸激酶受体1（sFlt - 1）的关联次之（HR 2.8 [95% CI 2.4 - 3.4]），其次是可溶性Toll样受体2（HR 2.3 [95% CI 2.0 - 2.8]）和肌酐（HR 1.9 [95% CI 1.6 - 2.4]）。在缺血性/非缺血性亚组中，BNP和TnI的关联仍然最强。除肌酐外，所有研究生物标志物在缺血性亚组中的HR较小，提示心肾相互作用在缺血性HF失代偿中更为重要。
虽然BNP和TnI与住院的关联最强，但其余生物标志物的病因依赖性关联提示HF加重存在病因特异性机制。sFlt - 1与心脏住院有很强的关联，突出了其作为HF发病率生物标志物的潜在作用。
