Darche Fabrice F, Baumgärtner Christian, Biener Moritz, Müller-Hennessen Matthias, Vafaie Mehrshad, Koch Vitali, Stoyanov Kiril, Rivinius Rasmus, Katus Hugo A, Giannitsis Evangelos
Department of Cardiology, Medical University Hospital Heidelberg, INF 410, D-69120, Heidelberg, Germany.
ESC Heart Fail. 2017 Aug;4(3):232-240. doi: 10.1002/ehf2.12150. Epub 2017 Apr 21.
To compare the performance of the natriuretic peptides (NPs) NT-proBNP and MR-proANP for the diagnosis of acute heart failure (AHF) in subsets of conditions potentially confounding the interpretation of NPs.
We studied 312 patients, presenting to the emergency department with new onset of dyspnoea or worsening of chronic dyspnoea within the last 2 weeks. Performance of NPs for the diagnosis of AHF was tested and compared using C-statistics in the entire cohort and in conditions previously described to confound interpretation of NPs such as older age, renal failure, obesity, atrial fibrillation or paced rhythm, and in the NT-proBNP grey zone. AHF was diagnosed in 139 patients. In the entire cohort, the diagnostic performance of NT-proBNP was comparable with that of MR-proANP. Receiver operating characteristic analysis demonstrated that optimal diagnostic cut-offs were higher in the presence of older age, kidney failure or rhythm disorder. However, there were no statistically relevant differences between the receiver operating characteristic curves analysed in the total population and those studied in the pre-specified subsets severe kidney failure, advanced age, obesity, atrial fibrillation and paced rhythm, and grey zone NT-proBNP values. Moreover, the diagnostic performance of NT-proBNP was comparable with that of MR-proANP in the subsets.
The performance of NT-proBNP and MR-proANP for AHF is comparable in the total population as well as in the subsets with potentially confounding characteristics such as older age, renal dysfunction, obesity, atrial fibrillation and paced rhythm, or those with NT-proBNP values in the grey zone.
比较利钠肽（NPs）N末端B型利钠肽原（NT-proBNP）和中段心房利钠肽前体（MR-proANP）在可能混淆NPs解读的疾病亚组中诊断急性心力衰竭（AHF）的性能。
我们研究了312例患者，这些患者在过去2周内因新发呼吸困难或慢性呼吸困难加重而就诊于急诊科。在整个队列以及先前描述的可能混淆NPs解读的疾病（如老年、肾衰竭、肥胖、心房颤动或起搏心律）中，以及在NT-proBNP灰色区域，使用C统计量测试并比较NPs对AHF的诊断性能。139例患者被诊断为AHF。在整个队列中，NT-proBNP的诊断性能与MR-proANP相当。受试者工作特征分析表明，在存在老年、肾衰竭或心律紊乱的情况下，最佳诊断临界值更高。然而，在总体人群中分析的受试者工作特征曲线与在预先指定的亚组（严重肾衰竭、高龄、肥胖、心房颤动和起搏心律）以及NT-proBNP灰色区域值中研究的曲线之间没有统计学上的显著差异。此外，在这些亚组中，NT-proBNP的诊断性能与MR-proANP相当。
NT-proBNP和MR-proANP对AHF的诊断性能在总体人群以及具有可能混淆特征的亚组（如老年、肾功能不全、肥胖、心房颤动和起搏心律）或NT-proBNP值处于灰色区域的亚组中相当。
