左心室射血分数正常的心力衰竭患者中，五聚体3水平升高的增量预后意义。
Incremental prognostic significance of the elevated levels of pentraxin 3 in patients with heart failure with normal left ventricular ejection fraction.
作者信息
Matsubara Junichi, Sugiyama Seigo, Nozaki Toshimitsu, Akiyama Eiichi, Matsuzawa Yasushi, Kurokawa Hirofumi, Maeda Hirofumi, Fujisue Koichiro, Sugamura Koichi, Yamamoto Eiichiro, Matsui Kunihiko, Jinnouchi Hideaki, Ogawa Hisao
机构信息
Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.) Department of Cardiovascular Medicine, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan (J.M.).
Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.) Department of Cardiovascular Medicine, and Diabetes Care Center, Jinnouchi Hospital, Kumamoto, Japan (S.S., H.J.).
出版信息
J Am Heart Assoc. 2014 Jul 10;3(4):e000928. doi: 10.1161/JAHA.114.000928.
BACKGROUND
Pentraxin 3 (PTX3) is a novel inflammatory marker produced by various cell types including those of the vasculature and the heart. The relationship between inflammatory markers and prognosis of patients with heart failure with normal ejection fraction (HFNEF) remains unknown. We investigated whether plasma PTX3 levels can predict future cardiovascular events in patients with HFNEF.
METHODS AND RESULTS
Plasma PTX3, high-sensitivity C-reactive protein, and B-type natriuretic peptide levels were measured prospectively in 360 stable patients with HFNEF. The subsequent incidence of cardiovascular events, including cardiovascular death, nonfatal myocardial infarction (MI), unstable angina pectoris, nonfatal ischemic stroke, hospitalization for heart failure decompensation, and coronary revascularization, was determined. During a mean 30-month follow-up, 106 patients experienced cardiovascular events. These events were more frequent in patients with high plasma PTX3 levels (>3.0 ng/mL) than low levels (≤3.0 ng/mL). Multivariable Cox hazard analysis showed that PTX3 (hazard ratio: 1.16; 95% CI: 1.05 to 1.27; P<0.01) and B-type natriuretic peptide (hazard ratio: 1.08; 95% CI: 1.03 to 1.14; P<0.001), but not high-sensitivity C-reactive protein levels, were significant predictors of future cardiovascular events. Multivariable Cox analysis with the forced inclusion model, including 5 previously identified prognostic factors, found that PTX3 was a significant predictor of cardiovascular events (hazard ratio: 1.16; 95% CI: 1.06 to 1.27; P<0.01). The C-statistics for cardiovascular events substantially increased from 0.617 to 0.683 when PTX3 was added to the 5 previously identified prognostic factors.
CONCLUSIONS
High plasma PTX3 levels, but not other inflammatory markers, are correlated with future cardiovascular events in patients with HFNEF. PTX3 may be a useful biomarker for assessment of risk stratification in HFNEF.
CLINICAL TRIAL REGISTRATION URL
http://www.umin.ac.jp; Unique identifier: UMIN000002170.
背景
五聚体3（PTX3）是一种由包括血管和心脏细胞类型在内的多种细胞产生的新型炎症标志物。射血分数正常的心力衰竭（HFNEF）患者炎症标志物与预后之间的关系尚不清楚。我们研究了血浆PTX3水平是否能预测HFNEF患者未来的心血管事件。
方法与结果
前瞻性测量了360例稳定的HFNEF患者的血浆PTX3、高敏C反应蛋白和B型利钠肽水平。确定了随后心血管事件的发生率，包括心血管死亡、非致命性心肌梗死（MI）、不稳定型心绞痛、非致命性缺血性中风、因心力衰竭失代偿住院以及冠状动脉血运重建。在平均30个月的随访期间，106例患者发生了心血管事件。这些事件在血浆PTX3水平高（>3.0 ng/mL）的患者中比低水平（≤3.0 ng/mL）的患者更频繁。多变量Cox风险分析显示，PTX3（风险比：1.16；95%CI：1.05至1.27；P<0.01）和B型利钠肽（风险比：1.08；95%CI：1.03至1.14；P<0.001），而非高敏C反应蛋白水平，是未来心血管事件的显著预测因素。采用强制纳入模型的多变量Cox分析，包括5个先前确定的预后因素，发现PTX3是心血管事件的显著预测因素（风险比：1.16；95%CI：1.06至1.27；P<0.01）。当将PTX3添加到5个先前确定的预后因素中时，心血管事件的C统计量从0.617大幅增加到0.683。
结论
高血浆PTX3水平而非其他炎症标志物与HFNEF患者未来的心血管事件相关。PTX3可能是评估HFNEF风险分层的有用生物标志物。
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