Omar Hesham R, Guglin Maya
Internal Medicine Department, Mercy Medical Center, Clinton, Iowa, USA.
Division of Cardiovascular Medicine, Linda and Jack Gill Heart Institute, University of Kentucky, Lexington, KY, USA.
Int J Cardiol. 2017 Apr 1;232:324-329. doi: 10.1016/j.ijcard.2016.12.069. Epub 2016 Dec 20.
The characteristics and outcomes of patients hospitalized with acute systolic heart failure (HF) and normal admission B-type natriuretic peptide (BNP) has not been previously explored.
Using the ESCAPE trial data, we compared patients with acute HF and left ventricular ejection fraction (LVEF) ≤30% who have either normal or elevated BNP on the day of hospitalization. The study endpoints were 30-day and 6-month mortality, all-cause rehospitalization and rehospitalization for HF.
Among 347 patients with acute systolic HF, 43 had normal (mean 50.6pg/mL) and 304 had elevated admission BNP (mean 1144pg/mL). Compared with patients with elevated BNP, those with normal admission BNP were younger (51.5 vs. 56.8years, P=0.01), with higher body mass index (33.6 vs. 28.7kg/m, P<0.0001), lower frequency of ischemic etiology for heart disease (20.9% vs. 51.7%, P<0.001), lower blood urea nitrogen (29.1 vs. 36.3mg/dL, P=0.005) and creatinine (1.34 vs. 1.52mg/dL, P=0.038) levels, higher LVEF (25.5% vs. 19.1%, P=0.018), higher cardiac index (2.34 vs. 1.96, P=0.013), and better diastolic function evident by lower E/A ratio (1.73 vs. 2.67, P=0.001) and longer deceleration of E velocity (166 vs. 141ms, P=0.028). There was no difference between patients with normal or elevated admission BNP with regards to the degree of congestion. There were no differences between both groups in post-discharge hard endpoints such as 30-day (P=0.101) and 6-month (P=0.143) mortality, rehospitalization for any cause (P=0.992) or for HF (P=0.763).
Patients hospitalized with acute systolic HF and normal admission BNP had no significant differences in the degree of congestion and post-discharge outcomes compared with those with elevated BNP. A normal BNP in this instance was not valuable for diagnostic or prognostic purposes.
既往尚未探讨过急性收缩性心力衰竭（HF）且入院时B型利钠肽（BNP）正常的患者的特征及预后。
利用ESCAPE试验数据，我们比较了急性HF且左心室射血分数（LVEF）≤30%、入院当天BNP正常或升高的患者。研究终点为30天和6个月死亡率、全因再住院率及因HF再住院率。
在347例急性收缩性HF患者中，43例入院时BNP正常（平均50.6pg/mL），304例入院时BNP升高（平均1144pg/mL）。与BNP升高的患者相比，入院时BNP正常的患者更年轻（51.5岁对56.8岁，P=0.01），体重指数更高（33.6对28.7kg/m，P<0.0001），心脏病缺血性病因发生率更低（20.9%对51.7%，P<0.001），血尿素氮水平更低（29.1对36.3mg/dL，P=0.005），肌酐水平更低（1.34对1.52mg/dL，P=0.038），LVEF更高（25.5%对19.1%，P=0.018），心脏指数更高（2.34对1.96，P=0.013），舒张功能更好，表现为E/A比值更低（1.73对2.67，P=0.001）及E波减速时间更长（166对141ms，P=0.028）。入院时BNP正常或升高的患者在充血程度方面无差异。两组在出院后硬终点方面无差异，如30天（P=0.101）和6个月（P=0.143）死亡率、任何原因的再住院率（P=0.992）或因HF再住院率（P=0.763）。
与入院时BNP升高的患者相比，急性收缩性HF且入院时BNP正常的患者在充血程度及出院后预后方面无显著差异。在此情况下，正常的BNP对诊断或预后无价值。
