Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Cardiology, Loyola University Medical Center, Maywood, Illinois.
J Card Fail. 2019 Sep;25(9):703-711. doi: 10.1016/j.cardfail.2019.04.002. Epub 2019 Apr 4.
Amino-terminal pro-B-type natriuretic peptide (NTproBNP) is closely associated with prognosis in acute decompensated heart failure (ADHF). As a result, there has been great interest measuring it during the course of treatment. The prognostic implications in both short-term and follow-up changes in NTproBNP need further clarification.
Baseline, 48-72 hour, and 30-day NTproBNP levels were measured in 795 subjects in the ASCEND-HF trial. Multivariable logistic and Cox-proportional hazards models were used to test the association between static, relative, and absolute changes in NTproBNP with outcomes during and after ADHF.
The median NTproBNP at baseline was 5773 (2981-11,579) pg/mL; at 48-72 hours was 3036 (1191-6479) pg/mL; and at 30 days was 2914 (1364-6667) pg/mL. Absolute changes in NTproBNP by 48-72 hours were not associated with 30-day heart failure rehospitalization or mortality (P = .065), relative changes in NTproBNP were nominally associated (P = .046). In contrast, both absolute and relative changes in NTproBNP from baseline to 48-72 hours and to 30 days were closely associated with 180-day mortality (P < .02 for all) with increased discrimination compared to the multivariable models with baseline NTproBNP (P <.05 for models with relative and absolute change at both time points).
Although the degree of absolute change in NTproBNP was dependent on baseline levels, both short-term absolute and relative changes in NTproBNP were independently and incrementally associated with long-term clinical outcomes. Changes in NTproBNP levels at 30-days were particularly well associated with long-term clinical outcomes.
氨基末端 B 型利钠肽前体（NTproBNP）与急性失代偿性心力衰竭（ADHF）的预后密切相关。因此，在治疗过程中测量它一直是人们关注的焦点。NTproBNP 的短期和随访变化的预后意义需要进一步阐明。
在 ASCEND-HF 试验中，对 795 例患者进行了基线、48-72 小时和 30 天的 NTproBNP 水平测量。多变量逻辑和 Cox 比例风险模型用于测试 NTproBNP 的静态、相对和绝对变化与 ADHF 期间和之后的结果之间的关系。
基线时 NTproBNP 的中位数为 5773（2981-11579）pg/ml；48-72 小时时为 3036（1191-6479）pg/ml；30 天时为 2914（1364-6667）pg/ml。48-72 小时 NTproBNP 的绝对变化与 30 天心力衰竭再入院或死亡率无关（P=0.065），相对变化具有名义相关性（P=0.046）。相比之下，NTproBNP 从基线到 48-72 小时和 30 天的绝对和相对变化均与 180 天死亡率密切相关（所有 P<0.02），与基线 NTproBNP 的多变量模型相比具有更好的区分能力（P<0.05，对于两个时间点的相对和绝对变化的模型）。
尽管 NTproBNP 的绝对变化程度取决于基线水平，但短期绝对和相对 NTproBNP 的变化与长期临床结局独立且呈递增关系。NTproBNP 水平在 30 天的变化与长期临床结局特别相关。
