Kato Yuko, Suzuki Shinya, Uejima Tokuhisa, Semba Hiroaki, Kano Hiroto, Matsuno Shunsuke, Takai Hideaki, Otsuka Takayuki, Oikawa Yuji, Nagashima Kazuyuki, Kirigaya Hajime, Sagara Koichi, Kunihara Takashi, Yajima Junji, Sawada Hitoshi, Aizawa Tadanori, Yamashita Takeshi
Department of Cardiovascular Medicine, The Cardiovascular Institute, Nishiazabu 3-2-19, Minato-ku, Tokyo, 106-0031, Japan.
Department of Cardiovascular Surgery, The Cardiovascular Institute, Tokyo, Japan.
Heart Vessels. 2017 Apr;32(4):428-435. doi: 10.1007/s00380-016-0887-x. Epub 2016 Aug 22.
This study aimed to examine the discrete impacts of peak oxygen consumption (VO) and brain natriuretic peptide (BNP) levels on future heart failure (HF) events in sinus rhythm (SR) and atrial fibrillation (AF). A total of 1447 patients who underwent symptom-limited cardiopulmonary exercise testing and whose BNP values were determined simultaneously were analysed (SR, N = 1151 and AF, N = 296). HF events were defined as HF hospitalization or HF death. Over a mean follow-up period of 1472 days, 140 HF events were observed. A high BNP value (dichotomized by median value) was independently associated with HF events in SR (HR 8.08; 95 % CI 4.02-16.26; p < 0.0001), but not in AF patients (HR 1.97; 95 % CI 0.91-4.28; p = 0.087) with a significant interaction between the rhythms. By contrast, low-peak VO was independently associated with HF events in both rhythms (AF; HR 5.81; 95 % CI 1.75-19.30; p = 0.004, SR; HR 2.04; 95 % CI 1.19-3.49; p = 0.009), with a marginal interaction between them. In bivariate Cox models, low-peak VO had much stronger predictive power for HF events than high-BNP in AF, whereas high-BNP was more powerful than low-peak VO in SR. The prognostic value of BNP and peak VO for future HF events seemed to be different between SR and AF.
本研究旨在探讨峰值耗氧量（VO）和脑钠肽（BNP）水平对窦性心律（SR）和心房颤动（AF）患者未来发生心力衰竭（HF）事件的独立影响。对1447例接受症状限制性心肺运动试验且同时测定BNP值的患者进行了分析（SR组1151例，AF组296例）。HF事件定义为HF住院或HF死亡。在平均1472天的随访期内，观察到140例HF事件。高BNP值（以中位数二分法划分）与SR患者的HF事件独立相关（HR 8.08；95%CI 4.02-16.26；p<0.0001），但在AF患者中无相关性（HR 1.97；95%CI 0.91-4.28；p=0.087），且两种心律之间存在显著交互作用。相比之下，低峰值VO与两种心律的HF事件均独立相关（AF组：HR 5.81；95%CI 1.75-19.30；p=0.004，SR组：HR 2.04；95%CI 1.19-3.49；p=0.009），两者之间存在微弱交互作用。在双变量Cox模型中，低峰值VO对AF患者HF事件的预测能力远强于高BNP，而在SR患者中高BNP比低峰值VO更具预测力。BNP和峰值VO对未来HF事件的预后价值在SR和AF之间似乎有所不同。
