Kasahara Shintaro, Sakata Yasuhiko, Nochioka Kotaro, Yamauchi Takeshi, Onose Takeo, Tsuji Kanako, Abe Ruri, Oikawa Takuya, Sato Masayuki, Aoyanagi Hajime, Miura Masanobu, Shiroto Takashi, Takahashi Jun, Miyata Satoshi, Shimokawa Hiroaki
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Heart Vessels. 2018 Sep;33(9):997-1007. doi: 10.1007/s00380-018-1150-4. Epub 2018 Mar 22.
We aimed to compare the usefulness of plasma levels of B-type natriuretic peptide (BNP) for long-term risk stratification among patients with heart failure (HF) with preserved left ventricular ejection fraction (LVEF) (HFpEF), borderline HFpEF, and HF with reduced LVEF (HFrEF) in the same HF cohort. In the CHART-2 Study (N = 10,219), we categorized 4301 consecutive Stage C/D HF patients (mean age 68.7 years, female 32.4%) into 3 groups: HFpEF (LVEF ≥ 50%, N = 2893), borderline HFpEF (LVEF 40-50%, N = 666), and HFrEF (LVEF ≤ 40%, N = 742). During the median 6.3-year follow-up, all-cause deaths occurred in 887 HFpEF, 330 borderline HFpEF, and 330 HFrEF patients. Although median BNP levels increased from HFpEF, borderline HFpEF to HFrEF (85.3, 126 and 208 pg/ml, respectively, P < 0.001), the relationship between log BNP levels and the mortality risk was comparable among the 3 groups. As compared with patients with BNP < 30 pg/ml, those with 30-99, 100-299 and ≥ 300 pg/ml had comparably increasing mortality risk among the 3 groups (hazard ratio 2.5, 4.7 and 7.8 in HFpEF, 2.1, 4.2 and 7.0 in borderline HFpEF, and 3.0, 4.7 and 9.5 in HFrEF, respectively, all P < 0.001). BNP levels have comparable prognostic impact among HFpEF, borderline HFpEF, and HFrEF patients.
我们旨在比较B型利钠肽（BNP）血浆水平在同一心力衰竭队列中，对射血分数保留的心力衰竭（HFpEF）、临界HFpEF和射血分数降低的心力衰竭（HFrEF）患者进行长期风险分层的有用性。在CHART - 2研究（N = 10219）中，我们将4301例连续的C/D期HF患者（平均年龄68.7岁，女性占32.4%）分为3组：HFpEF（左心室射血分数[LVEF]≥50%，N = 2893）、临界HFpEF（LVEF 40 - 50%，N = 666）和HFrEF（LVEF≤40%，N = 742）。在中位6.3年的随访期间，887例HFpEF、330例临界HFpEF和330例HFrEF患者发生了全因死亡。虽然BNP水平中位数从HFpEF、临界HFpEF到HFrEF逐渐升高（分别为85.3、126和208 pg/ml，P < 0.001），但3组中log BNP水平与死亡风险之间的关系具有可比性。与BNP < 30 pg/ml的患者相比，BNP为30 - 99、100 - 299和≥300 pg/ml的患者在3组中的死亡风险均呈相应增加（HFpEF组的风险比分别为2.5、4.7和7.8，临界HFpEF组为2.1、4.2和7.0，HFrEF组为3.0、4.7和9.5，均P < 0.001）。BNP水平在HFpEF、临界HFpEF和HFrEF患者中具有相似的预后影响。
