Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan; Division of Cardiology, West Virginia University, Morgantown, West Virginia; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
J Card Fail. 2019 Sep;25(9):712-721. doi: 10.1016/j.cardfail.2019.04.004. Epub 2019 Apr 6.
Prognostication of patients discharged after acute heart failure (AHF) hospitalization remains challenging. Body weight (BW) reduction is often used as a surrogate marker of decongestion despite the paucity of evidence. We thought to test the hypothesis that B-type natriuretic peptide (BNP) reduction during hospitalization has independent prognostic value in AHF.
We studied the prognostic predictability of percentage BNP reduction achieved during hospitalization in patients from the REALITY-AHF study. Percentage BNP reduction was defined as (BNP on admission - BNP at discharge) / BNP on admission × 100. The primary endpoint was 1-year all-cause death. In 1028 patients (age, 77 ± 13 years; 57% male; left ventricular ejection fraction, 47 ± 16%) with AHF, median BNP level at admission was 747 ng/L (interquartile range, 439-1367 ng/L) and median percentage BNP reduction was 62.5% (interquartile range, 36.5-78.5%). The smallest percentage BNP reduction quartile had more than 2-fold higher risk of all-cause death than the greatest quartile (23.0% vs 9.7%, P< .001). After adjusting for covariates including BNP at discharge, the percentage BNP reduction was significantly associated with all-cause death (hazard ratio 0.96, 95% confidence interval 0.93-0.99, P= .032), whereas percentage BW reduction was not. Percentage BNP reduction was more predictive in patients with heart failure with reduced ejection fraction than in those with preserved ejection fraction.
The prognostic value of percentage BNP reduction during hospitalization was superior to that of percentage BW reduction and was independent of other risk markers, including BNP at discharge.
急性心力衰竭（AHF）出院后患者的预后仍然具有挑战性。尽管缺乏证据，但体重减轻通常被用作充血消退的替代标志物。我们试图检验这样一个假设，即在 AHF 住院期间 B 型利钠肽（BNP）的降低具有独立的预后价值。
我们研究了 REALITY-AHF 研究中住院期间 BNP 降低百分比对患者预后的预测能力。BNP 降低百分比定义为（入院时的 BNP - 出院时的 BNP）/入院时的 BNP×100。主要终点是 1 年全因死亡率。在 1028 例 AHF 患者（年龄 77±13 岁；57%为男性；左心室射血分数 47±16%）中，入院时 BNP 中位数为 747ng/L（四分位间距 439-1367ng/L），BNP 降低中位数为 62.5%（四分位间距 36.5-78.5%）。BNP 降低最小四分位数患者的全因死亡率是 BNP 降低最大四分位数患者的两倍以上（23.0% vs. 9.7%，P<.001）。在校正包括出院时 BNP 在内的协变量后，BNP 降低百分比与全因死亡率显著相关（风险比 0.96，95%置信区间 0.93-0.99，P=.032），而体重降低百分比则不然。在射血分数降低的心力衰竭患者中，BNP 降低百分比比射血分数保留的心力衰竭患者更具预测性。
住院期间 BNP 降低百分比的预后价值优于体重降低百分比，并且独立于其他风险标志物，包括出院时的 BNP。
