Ribeiro Ana, Lourenço Patrícia, Silva Sérgio, Cunha Francisco, Vilaça João, Gomes Filipa, Araújo José Paulo, Bettencourt Paulo
Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal.
Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Porto, Portugal.
Am J Cardiol. 2015 Jan 1;115(1):69-74. doi: 10.1016/j.amjcard.2014.09.053. Epub 2014 Oct 15.
Increasing natriuretic peptide (NP) levels are associated with worse heart failure (HF) outcomes. Predictors of NP nonresponse have not been studied. The aim of this study was to identify predictors of nondecreasing NP levels during episodes of acute HF. A retrospective analysis was conducted in patients prospectively included in a registry of acute HF, with the primary diagnosis of acute HF. The objective under analysis was B-type NP (BNP) response, defined as a >30% decrease in BNP during hospitalization. Percentage of BNP variation was calculated as: % BNP variation = [(admission BNP - discharge BNP)/admission BNP] × 100. A logistic regression analysis was performed to study potential predictors of NP nonresponse. A multivariate model was built. A total of 496 patients were studied: 28.2% were considered nonresponders to the implemented HF treatment strategy. Identified predictors of nonresponse were older age, chronic HF, lower admission systolic blood pressure, anemia, renal dysfunction, and lower sodium on admission, as well as lower admission albumin and lower admission total cholesterol. Admission BNP was not a predictor of response. The only identified independent predictor of nonresponse was a low admission total cholesterol level (cutoff 125 mg/dl), with an odds ratio of 2.55 (95% confidence interval 1.59 to 4.11). This remained valid when the analysis was stratified according to admission BNP (cutoff 2,000 pg/ml) and according to statin use. In conclusion, a low admission total cholesterol level was a strong and independent predictor of BNP nonresponse in patients admitted with acute HF. The ability of cholesterol to predict BNP nonresponse was valid for patients with intrinsically low cholesterol and in those with statin-induced low cholesterol.
利钠肽（NP）水平升高与心力衰竭（HF）预后较差相关。NP无反应的预测因素尚未得到研究。本研究的目的是确定急性HF发作期间NP水平未降低的预测因素。对前瞻性纳入急性HF登记册且主要诊断为急性HF的患者进行了回顾性分析。分析的目标是B型NP（BNP）反应，定义为住院期间BNP降低>30%。BNP变化百分比的计算方法为：%BNP变化 = [（入院时BNP - 出院时BNP）/入院时BNP]×100。进行逻辑回归分析以研究NP无反应的潜在预测因素。构建了一个多变量模型。共研究了496例患者：28.2%的患者被认为对实施的HF治疗策略无反应。确定的无反应预测因素包括年龄较大、慢性HF、入院时收缩压较低、贫血、肾功能不全、入院时钠水平较低，以及入院时白蛋白较低和入院时总胆固醇较低。入院时BNP不是反应的预测因素。唯一确定的无反应独立预测因素是入院时总胆固醇水平低（临界值125 mg/dl），比值比为2.55（95%置信区间1.59至4.11）。当根据入院时BNP（临界值2000 pg/ml）和他汀类药物使用情况进行分层分析时，这一结果仍然有效。总之，入院时总胆固醇水平低是急性HF入院患者BNP无反应的一个强有力的独立预测因素。胆固醇预测BNP无反应的能力对于内源性胆固醇低的患者和他汀类药物引起的胆固醇低的患者均有效。
