Streng Koen W, Ter Maaten Jozine M, Cleland John G, O'Connor Christopher M, Davison Beth A, Metra Marco, Givertz Michael M, Teerlink John R, Ponikowski Piotr, Bloomfield Daniel M, Dittrich Howard C, Hillege Hans L, van Veldhuisen Dirk J, Voors Adriaan A, van der Meer Peter
From the Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands (K.W.S., J.M.t.M., H.L.H., D.J.v.V., A.A.V., P.v.d.M.); National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, United Kingdom (J.G.C.); Inova Heart and Vascular Institute, Falls Church, VA (C.M.O'C.); Momentum Research, Durham, NC (B.A.D.); University of Brescia, Italy (M.M.); Brigham and Women's Hospital, Boston, MA (M.M.G.); University of California at San Francisco and San Francisco Veterans Affairs Medical Center (J.R.T.); Medical University, Clinical Military Hospital, Wroclaw, Poland (P.P.); Merck Research Laboratories, Rahway, NJ (D.M.B.); and University of Iowa Carver College of Medicine Cardiovascular Research Center (H.C.D.).
Circ Heart Fail. 2017 Jan;10(1). doi: 10.1161/CIRCHEARTFAILURE.116.003350.
Plasma concentrations of natriuretic peptides decline with obesity in patients with heart failure. Whether this is true for other biomarkers is unknown. We investigated a wide range of biomarker profiles in acute heart failure across the body mass index (BMI) spectrum.
A total of 48 biomarkers, assessing multiple pathophysiological pathways, were measured in 2033 patients included in PROTECT (Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized With Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function), a trial comparing the effects of rolofylline to placebo in patients with acute heart failure. Patients were classified into 4 groups according to BMI (<25, 25-30, 30-35, and >35 kg/m). Of 2003 patients with known weight and height, mean age was 70±12 years and 67% were men. Patients with a higher BMI (>35 kg/m) had higher blood pressures, were younger, and were more often women. Median levels of brain natriuretic peptide were 550 pg/mL in patients with a BMI <25 kg/m and 319 pg/mL in patients with a BMI >35 kg/m (P<0.001). Multivariable regression revealed that brain natriuretic peptide (β=-0.250; P<0.001) and receptor for advanced glycation endproducts (β=-0.095; P<0.007) were inversely correlated to BMI, whereas higher levels of uric acid (β=0.164; P<0.001), proadrenomedullin (β=0.171; P<0.001), creatinine (β=0.118; P=0.003), sodium (β=0.101; P=0.006), and bicarbonate (β=0.094; P=0.009) were associated with higher BMI. No significant interaction was seen between these 7 biomarkers and BMI on 180-day mortality.
The plasma concentrations of several biomarkers are either positively or negatively influenced by BMI. These findings suggest that these markers should be interpreted with caution in patients with obesity. Although concentrations differ, their prognostic value for mortality up to 180 days did not differ.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00354458.
在心力衰竭患者中，利钠肽的血浆浓度会随着肥胖程度的增加而下降。其他生物标志物是否也是如此尚不清楚。我们研究了不同体重指数（BMI）范围内急性心力衰竭患者的多种生物标志物谱。
在PROTECT（一项关于选择性A1腺苷受体拮抗剂罗氟司特对急性失代偿性心力衰竭和容量超负荷住院患者的治疗效果评估的安慰剂对照随机研究）纳入的2033例患者中，检测了48种评估多种病理生理途径的生物标志物，该试验比较了罗氟司特与安慰剂对急性心力衰竭患者的疗效。根据BMI将患者分为4组（<25、25 - 30、30 - 35和>35kg/m²）。在2003例已知体重和身高的患者中，平均年龄为70±12岁，67%为男性。BMI较高（>35kg/m²）的患者血压更高、更年轻，且女性更为常见。BMI<25kg/m²的患者脑钠肽中位数水平为550pg/mL，而BMI>35kg/m²的患者为319pg/mL（P<0.001）。多变量回归显示，脑钠肽（β=-0.250；P<0.001）和晚期糖基化终产物受体（β=-0.095；P<0.007）与BMI呈负相关，而尿酸（β=0.164；P<0.001）、肾上腺髓质素原（β=0.171；P<0.001）、肌酐（β=0.118；P=0.003）、钠（β=0.101；P=0.006）和碳酸氢盐（β=0.094；P=0.009）水平较高与较高的BMI相关。这7种生物标志物与BMI之间在180天死亡率方面未发现显著相互作用。
多种生物标志物的血浆浓度受BMI的正向或负向影响。这些发现表明，在肥胖患者中对这些标志物的解读应谨慎。尽管浓度不同，但它们对180天内死亡率的预后价值并无差异。
