Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milano, Italy.
Department of Cardiothoracic and Vascular Anesthesia & ICU, I.R.C.C.S. Policlinico San Donato, Milan, Italy.
Int J Cardiol. 2018 Jun 1;260:24-30. doi: 10.1016/j.ijcard.2018.02.084. Epub 2018 Feb 26.
Plasma concentrations of natriuretic peptides have been shown to predict prognosis in heart failure (HF) patients with left ventricle (LV) dysfunction. It is still unclear if measurements after cardiac surgery are associated with any effect on the outcome. We aimed to prospectively investigate the longitudinal profile of serial evaluations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in ischemic HF patients undergoing Surgical Ventricular Reconstruction (SVR) and how NT-proBNP levels at different time-points are associated with the outcome.
One hundred and forty-three patients (122 men, 64 ± 9 years old) with post-infarction LV remodeling referred to our Center for SVR had an assessment of NT-proBNP levels before surgery and 6, 12 and 18 months after surgery. The analysis was performed using the logarithm of the biomarker and joint modeling of serial measurements through mixed models together with Cox regression to analyze time to event data.
The average level of the biomarker decreased by about 50% during the first year after the operation. Time-varying NT-proBNP levels were associated with the hazard of: 1% increase in NT-proBNP during the follow-up was associated with 1.5% increase of the risk of the composite event (95% CI: 1.0%, 2.6%) and with 4.2% increase of the risk of death (95% CI: 2.2%, 8.2%).
Serial profiles (either in increasing or in decreasing) at different time points are associated with a modulation of the risk of adverse events and, therefore, are important indicators for monitoring the evolution of the disease, even after cardiac surgery.
已有研究表明，心力衰竭（HF）伴左心室（LV）功能障碍患者的血浆利钠肽浓度可预测预后。心脏手术后的测量值是否与结局相关尚不清楚。我们旨在前瞻性研究缺血性 HF 患者接受心脏外科手术重建（SVR）后连续评估 N 末端 pro-B 型利钠肽（NT-proBNP）水平的纵向特征，以及不同时间点的 NT-proBNP 水平与结局的关系。
143 名（122 名男性，64±9 岁）因梗死后 LV 重构而转至我们中心接受 SVR 的患者在术前和术后 6、12 和 18 个月评估了 NT-proBNP 水平。通过混合模型对生物标志物进行对数分析，并对串行测量值进行联合建模，同时使用 Cox 回归分析时间事件数据。
术后第一年，生物标志物的平均水平下降了约 50%。时变 NT-proBNP 水平与危险比相关：随访期间 NT-proBNP 增加 1%，复合事件的风险增加 1.5%（95%CI：1.0%，2.6%），死亡风险增加 4.2%（95%CI：2.2%，8.2%）。
不同时间点的系列（增加或减少）与不良事件风险的调节相关，因此，即使在心脏手术后，也可作为监测疾病演变的重要指标。
