Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Hull, United Kingdom; Faculty of Medical Science, Anglia Ruskin University, United Kingdom.
Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Hull, United Kingdom.
Int J Cardiol. 2018 Oct 15;269:196-200. doi: 10.1016/j.ijcard.2018.06.070. Epub 2018 Jun 25.
Prognostic models for patients with chronic heart failure are generally based on a single assessment but treatment is often given with the intention of changing risk; re- evaluation of risk is an important aspect of care. The prognostic value of serial measurements of natriuretic peptides for the assessment of changes in risk is uncertain.
To evaluate the prognostic value of serial measurements of plasma amino-terminal pro-brain natriuretic peptide (NT-proBNP) during follow-up of out-patients with chronic heart failure (CHF).
Patients diagnosed with CHF between 2001 and 2014 at a single out-patient clinic serving a local community were included in this analysis. NT-proBNP was measured at the initial visit and serially during follow-up. Only patients who had one or more measurements of NT-proBNP after baseline, at 4, 12 and/or 24 months were included.
At baseline, amongst 1998 patients enrolled, the median age was 73 (IQR: 64-79) years, 70% were men, 31% were in NYHA class III/IV, and 77% had NT-proBNP >400 pg/mL. Median follow-up was 4.8 (IQR: 2.5-8.6) years. Serial measurements of NT-proBNP improved prediction of all-cause mortality at 3 years (c- statistic = 0.71) compared with using baseline data only (c-statistic = 0.67; p < 0.001) but a model using only the most recent NT-proBNP had an even higher c-statistic (0.72; p < 0.001). Similar results were obtained based on long-term prediction of mortality using all available follow-up data.
Serial measurement of NT-proBNP in patients with CHF improves prediction of all-cause mortality. However, using the most recent value of NT-proBNP has similar predictive power as using serial measurements.
慢性心力衰竭患者的预后模型通常基于单次评估，但治疗通常是为了改变风险而进行的；重新评估风险是护理的一个重要方面。连续测量利钠肽对评估风险变化的预后价值尚不确定。
评估慢性心力衰竭（CHF）门诊患者随访期间连续测量血浆氨基末端脑利钠肽前体（NT-proBNP）的预后价值。
本分析纳入了 2001 年至 2014 年间在一家服务于当地社区的单一门诊诊所被诊断为 CHF 的患者。在首次就诊时和随访期间连续测量 NT-proBNP。仅纳入基线后、4、12 和/或 24 个月有 1 次或多次 NT-proBNP 测量值的患者。
在 1998 名入组患者中，基线时的中位年龄为 73（IQR：64-79）岁，70%为男性，31%为 NYHA 心功能分级 III/IV 级，77%的患者 NT-proBNP >400 pg/mL。中位随访时间为 4.8（IQR：2.5-8.6）年。与仅使用基线数据相比，连续测量 NT-proBNP 可改善 3 年全因死亡率的预测（c 统计量=0.71；p < 0.001），但仅使用最新的 NT-proBNP 构建的模型具有更高的 c 统计量（0.72；p < 0.001）。基于所有可用随访数据的长期死亡率预测，也得到了类似的结果。
连续测量 CHF 患者的 NT-proBNP 可改善全因死亡率的预测。然而，使用最新的 NT-proBNP 值与使用连续测量值具有相似的预测能力。
