Skvortsov A A, Koshkina D E, Narusov O Yu, Protasov V N, Masenko V P, Tereshchenko S N
Institute of Cardiology of Russian Cardiology Scientific and Production Complex, Moscow, Russia.
Kardiologiia. 2016 Jul;56(7):25-38. doi: 10.18565/cardio.2016.7.25-38.
to compare efficacy of treatment of high risk patients after acute decompensation (AD) of chronic heart failure (CHF) based on monitoring of NT-proBNP concentration and standard treatment.
Patients (n=100) with class III-IV CHF and left ventricular ejection fraction (LV EF) <40% due to ischemic heart disease (IHD), dilated cardiomyopathy (DCMP), or arterial hypertension (AH) after compensation of HF before discharge were distributed into groups of low (NT-proBNP <1400 picog/ml, n=30) or high (NT-proBNP more or equal 1400 picog/ml, n=70) risk. High risk patients were randomized into 2 treatment groups: NT-proBNP based (group I, n=35) and standard (group II, n=35) therapy. At study closure we formed another group consisting of group I and II participants noncomplaint with study protocol (group NC, n=10). Groups practically did not differ by main clinical functional characteristics. Aim of treatment was lowering of NT-proBNP level below 1000 picog/ml or more or equal 50% from baseline. At discharge median NT-proBNP concentration was 3750.0 (2224.0; 6613.0), 2783.0 (2021.5; 4827.5), and 2162.0 (1684.5; 5750.0) picog/ml in groups I, II, and NC, respectively (=0.315).
At study entry all group I and II patients received combination of angiotensin converting enzyme inhibitors or angiotensin receptor blockers, -adrenoblockers, antagonists of mineralocorticoid receptors. After 6 months changes of doses of neuro-hormonal modulators in group I were more pronounced than in group II. NT-proBNP concentration decreased by 53% down to 1585.5 (976,6; 2742,5) picog/ml, =0.001, and by 10.2% in groups I and II, respectively (between group =0.001). In group I compared with II we observed more pronounced improvement of clinical functional indicators, quality of life, and parameters of systolic and diastolic LV function (<0.05), fewer cardiovascular deaths (4 vs. 10, =0.033) and repeat decompensations and rehospitalizations because CHF (4 vs. 14, =0.007).
Compared with standard therapy long-term NT-proBNP guided treatment of high risk patients significantly significantly decreased rate of CV deaths and repeat decompensations and rehospitalizations because CHF, and more effectively influenced clinical and functional state, quality of life and main echocardiographical parameters of LV systolic and diastolic function.
基于N末端B型利钠肽原（NT-proBNP）浓度监测和标准治疗，比较慢性心力衰竭（CHF）急性失代偿（AD）后高危患者的治疗效果。
将出院前心力衰竭已得到代偿、因缺血性心脏病（IHD）、扩张型心肌病（DCMP）或动脉高血压（AH）导致Ⅲ-Ⅳ级CHF且左心室射血分数（LV EF）<40%的患者（n = 100）分为低风险组（NT-proBNP<1400皮克/毫升，n = 30）和高风险组（NT-proBNP≥1400皮克/毫升，n = 70）。高风险患者被随机分为2个治疗组：基于NT-proBNP的治疗组（Ⅰ组，n = 35）和标准治疗组（Ⅱ组，n = 35）。在研究结束时，我们组建了另一个由不遵守研究方案的Ⅰ组和Ⅱ组参与者组成的组（NC组，n = 10）。各小组在主要临床功能特征方面实际无差异。治疗目标是将NT-proBNP水平降至1000皮克/毫升以下或较基线水平降低≥50%。出院时，Ⅰ组、Ⅱ组和NC组的NT-proBNP浓度中位数分别为3750.0（2224.0；6613.0）、2783.0（2021.5；4827.5）和2162.0（1684.5；5750.0）皮克/毫升（P = 0.315）。
在研究开始时，所有Ⅰ组和Ⅱ组患者均接受了血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂、β受体阻滞剂、盐皮质激素受体拮抗剂的联合治疗。6个月后，Ⅰ组神经激素调节剂剂量的变化比Ⅱ组更明显。Ⅰ组NT-proBNP浓度下降了53%，降至1585.5（976.6；2742.5）皮克/毫升，P = 0.001，Ⅱ组下降了10.2%（两组间P = 0.001）。与Ⅱ组相比，Ⅰ组的临床功能指标、生活质量以及左心室收缩和舒张功能参数有更明显改善（P<0.05），心血管死亡更少（4例对10例，P = 0.033），因CHF导致的再次失代偿和再次住院更少（4例对14例，P = 0.007）。
与标准治疗相比，长期NT-proBNP指导的高危患者治疗显著降低了心血管死亡以及因CHF导致的再次失代偿和再次住院率，并且更有效地影响了临床和功能状态、生活质量以及左心室收缩和舒张功能的主要超声心动图参数。
