Bayes-Genis Antoni, Barallat Jaume, de Antonio Marta, Domingo Mar, Zamora Elisabet, Vila Joan, Subirana Isaac, Gastelurrutia Paloma, Pastor M Cruz, Januzzi James L, Lupón Josep
Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Medicina, Barcelona, Spain; CIBERCV (CB16/11/00403), Instituto de Salud Carlos III, Madrid, Spain.
Servicio de Bioquímica, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
Rev Esp Cardiol (Engl Ed). 2017 Nov;70(11):924-932. doi: 10.1016/j.rec.2017.02.021. Epub 2017 Mar 6.
In the brain, amyloid-beta generation participates in the pathophysiology of cognitive disorders; in the bloodstream, the role of amyloid-beta is uncertain but may be linked to sterile inflammation and senescence. We explored the relationship between blood levels of amyloid-beta 1-40 peptide (Aβ40), cognition, and mortality (all-cause, cardiovascular, and heart failure [HF]-related) in ambulatory patients with HF.
Bloodstream Aβ40 was measured in 939 consecutive patients with HF. Cognition was evaluated with the Pfeiffer questionnaire (adjusted for educational level) at baseline and during follow-up. Multivariate Cox regression analyses and measurements of performance (discrimination, calibration, and reclassification) were used, with competing risk for specific causes of death.
Over 5.1 ± 2.9 years, 471 patients died (all-cause): 250 from cardiovascular causes and 131 HF-related. The median Aβ40 concentration was 519.1 pg/mL [Q1-Q3: 361.8-749.9 pg/mL]. The Aβ40 concentration correlated with age, body mass index, renal dysfunction, and New York Heart Association functional class (all P < .001). There were no differences in Aβ40 in patients with and without cognitive impairment at baseline (P = .97) or during follow-up (P = .20). In multivariable analysis, including relevant clinical predictors and N-terminal pro-B-type natriuretic peptide, Aβ40 remained significantly associated with all-cause death (HR, 1.22; 95%CI, 1.10-1.35; P < .001) and cardiovascular death (HR, 1.18; 95%CI, 1.03-1.36; P = .02), but not with HF-related death (HR, 1.13; 95%CI, 0.93-1.37; P = .22). Circulating Aβ40 improved calibration and patient reclassification.
Blood levels of Aβ40 are not associated with cognitive decline in HF. Circulating Aβ40 was predictive of mortality and may indicate systemic aging.
在大脑中，β淀粉样蛋白的生成参与认知障碍的病理生理过程；在血液中，β淀粉样蛋白的作用尚不确定，但可能与无菌性炎症和衰老有关。我们探讨了门诊心力衰竭（HF）患者血液中β淀粉样蛋白1-40肽（Aβ40）水平、认知与死亡率（全因、心血管疾病和心力衰竭（HF）相关）之间的关系。
对939例连续的HF患者测量血液中的Aβ40。在基线和随访期间，使用Pfeiffer问卷（根据教育水平进行调整）评估认知情况。采用多变量Cox回归分析和性能测量（辨别力、校准和重新分类），对特定死因采用竞争风险分析。
在5.1±2.9年的时间里，471例患者死亡（全因）：250例死于心血管疾病，131例死于HF相关原因。Aβ40浓度的中位数为519.1 pg/mL[四分位间距：361.8-749.9 pg/mL]。Aβ40浓度与年龄、体重指数、肾功能不全和纽约心脏协会功能分级相关（均P<.001）。在基线时（P=.97）或随访期间（P=.20），有认知障碍和无认知障碍的患者Aβ40水平无差异。在多变量分析中，包括相关临床预测因素和N末端前B型利钠肽，Aβ40仍与全因死亡（风险比，1.22；95%置信区间，1.10-1.35；P<.001）和心血管死亡（风险比，1.18；95%置信区间，1.03-1.36；P=.02）显著相关，但与HF相关死亡无关（风险比，1.13；95%置信区间，0.93-1.37；P=.22）。循环Aβ40改善了校准和患者重新分类。
HF患者血液中的Aβ40水平与认知功能下降无关。循环Aβ40可预测死亡率，可能提示全身衰老。
