Heart Failure Clinic, Health Sciences Research Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Heart Failure Clinic, Health Sciences Research Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.
Int J Cardiol. 2018 Apr 15;257:188-192. doi: 10.1016/j.ijcard.2018.01.119. Epub 2018 Jan 31.
Recent ESC guidelines on heart failure (HF) have introduced a new phenotype based on left ventricular ejection fraction (LVEF), called the mid-range (HFmrEF). This phenotype falls between the classical reduced (HFrEF) and preserved (HFpEF) HF phenotypes. We aimed to characterize the HFmrEF biomarker profile and outcomes.
1069 consecutive ambulatory patients were included in the study (age 66.2 ± 12.8 years); 800 with HFrEF (74.8%), 134 with HFmrEF (12.5%), and 135 with HFpEF (12.5%). We measured serum concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hs-TnT), soluble suppression of tumorigenicity (ST2), galectin-3, high-sensitivity C-reactive protein, cystatin-C, neprilysin, and soluble transferrin receptor, during 4.9 ± 2.8 years of follow-up. The primary end-point was the composite: cardiovascular death or HF-related hospitalization. We also examined all-cause, cardiovascular death, and the composite: all-cause death or HF-related hospitalization.
NTproBNP levels in HFmrEF were similar to levels in HFpEF, but significantly lower than levels in HFrEF. No other studied biomarkers were different between HFmrEF and HFrEF. All biomarkers, except neprilysin, showed higher risk prediction capabilities in HFmrEF than in HFrEF or HFpEF. The largest difference between HFrEF and HFmrEF was the hs-TnT level (hazard ratio [HR]: 4.72, 95% CI: 2.81-7.94 vs. HR: 1.67, 95%CI: 1.74-1.89; all p < 0.001).
Although HFmrEF is acknowledged as an intermediate phenotype between HFrEF and HFpEF, from a multi-biomarker point of view, HFmrEF was similar to HFrEF, except that NTproBNP levels were lower. Biomarkers commonly used for HFrEF risk prediction are more valuable for HFmrEF risk stratification.
最近 ESC 心力衰竭（HF）指南引入了一种基于左心室射血分数（LVEF）的新表型，称为中间范围（HFmrEF）。这种表型介于经典的射血分数降低（HFrEF）和射血分数保留（HFpEF）心力衰竭表型之间。我们旨在描述 HFmrEF 生物标志物特征和结局。
研究纳入了 1069 例连续门诊患者（年龄 66.2±12.8 岁）；800 例为 HFrEF（74.8%），134 例为 HFmrEF（12.5%），135 例为 HFpEF（12.5%）。我们在 4.9±2.8 年的随访期间测量了血清 N 末端脑利钠肽前体（NT-proBNP）、高敏肌钙蛋白 T（hs-TnT）、可溶性肿瘤抑制物 2（ST2）、半乳糖凝集素-3、高敏 C 反应蛋白、胱抑素-C、内肽酶和可溶性转铁蛋白受体的浓度。主要终点是复合终点：心血管死亡或 HF 相关住院。我们还检查了全因死亡、心血管死亡和复合终点：全因死亡或 HF 相关住院。
HFmrEF 的 NTproBNP 水平与 HFpEF 相似，但明显低于 HFrEF。其他研究的生物标志物在 HFmrEF 与 HFrEF 之间没有差异。除内肽酶外，所有生物标志物在 HFmrEF 中的风险预测能力均高于 HFrEF 或 HFpEF。HFrEF 和 HFmrEF 之间最大的差异是 hs-TnT 水平（风险比 [HR]：4.72，95%CI：2.81-7.94 vs. HR：1.67，95%CI：1.74-1.89；均 p<0.001）。
尽管 HFmrEF 被认为是 HFrEF 和 HFpEF 之间的中间表型，但从多生物标志物的角度来看，HFmrEF 与 HFrEF 相似，只是 NTproBNP 水平较低。常用于 HFrEF 风险预测的生物标志物对 HFmrEF 风险分层更有价值。
