Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Heart & Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
Int J Cardiol. 2019 Jul 15;287:66-72. doi: 10.1016/j.ijcard.2019.04.023. Epub 2019 Apr 11.
The aim was to assess sex-specific differences in N-terminal B-type natriuretic peptide (NT-proBNP) regarding concentrations, predictors of high concentrations, and prognostic role, in a large and unselected population with chronic heart failure (HF) with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF).
In 9847 outpatients with HFpEF, HFmrEF, and HFrEF (49 vs. 35 vs. 25% females, respectively) from the Swedish HF Registry, median NT-proBNP concentrations were 1598 ng/L in females vs. 1310 ng/L in males in HFpEF, 1764 vs. 1464 ng/L in HFmrEF, and 2543 vs. 2226 ng/L in HFrEF (p < 0.05 for all). The differences persisted after multiple adjustment. The largest sex-difference in NT-proBNP levels was observed in HFpEF with sinus rhythm, where median concentrations were 1.4 folds higher in females (923 vs. 647 ng/L). Independent predictors of NT-proBNP levels (defined as above the different medians according to sex and HF phenotype) were overall consistent across sexes and EF. NT-proBNP levels were similarly associated with risk of all-cause death/HF hospitalization in both sexes regardless of EF.
Concentrations of NT-proBNP were higher in females across the EF spectrum, with larger relative differences in HFpEF with sinus rhythm. However, similar predictors of high levels were observed in both sexes. There were no sex-differences in the prognostic role of NT-proBNP. These findings support the use of NT-proBNP for prognostic purposes in chronic HF, regardless of sex.
评估 N 端脑利钠肽前体（NT-proBNP）在性别方面的差异，包括浓度、高浓度的预测因素以及在具有保留射血分数（HFpEF）、中间范围射血分数（HFmrEF）和射血分数降低（HFrEF）的慢性心力衰竭（HF）的大型未选择人群中的预后作用。
在来自瑞典 HF 登记处的 9847 名 HFpEF、HFmrEF 和 HFrEF 的门诊患者（女性分别为 49%、35%和 25%）中，HFpEF 中女性的 NT-proBNP 中位数浓度为 1598ng/L，男性为 1310ng/L；HFmrEF 中分别为 1764ng/L 和 1464ng/L；HFrEF 中分别为 2543ng/L 和 2226ng/L（所有差异均 P<0.05）。即使经过多次调整，差异仍然存在。在窦性节律的 HFpEF 中，NT-proBNP 水平的性别差异最大，女性的中位数浓度高出 1.4 倍（923ng/L 对 647ng/L）。NT-proBNP 水平的独立预测因素（根据性别和 HF 表型定义为高于不同性别和 EF 的中位数）在两性之间总体上是一致的。无论 EF 如何，NT-proBNP 水平与全因死亡/HF 住院风险均呈相似相关性。
在 EF 谱中，女性的 NT-proBNP 浓度较高，窦性节律的 HFpEF 中相对差异更大。然而，两性中观察到的高水平的相似预测因素。NT-proBNP 的预后作用没有性别差异。这些发现支持将 NT-proBNP 用于慢性 HF 的预后目的，而与性别无关。
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