Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Lyon, France.
J Hypertens. 2020 Jan;38(1):65-72. doi: 10.1097/HJH.0000000000002225.
Plasma N-terminal pro brain natriuretic peptide (NT-proBNP) and R wave in aVL lead (RaVL) have been associated with mortality in hypertension. The aim of the current study was to compare the prognostic value of their combination to that of the left ventricular mass index (LVMI) assessed by echocardiography.
A total of 1104 hypertensive patients who had at baseline an assessment of plasma NT-proBNP, a 12-lead ECG, and echocardiography were included. LVMI was assessable in 921 patients. After a median (interquartile range) follow-up of 8.5 (5.4-13.3) years, 110 deaths occurred, 62 of which were from a cardiovascular cause.
Optimal thresholds of RaVL and plasma NT-proBNP to predict mortality were 0.7 mV and 150 pg/ml, respectively. A three-modality variable based on RaVL and NT-proBNP was built: 0 when none were above the threshold, 1 or 2 when only one or both were above the threshold. After adjustment for all confounders including LVMI indexed to height raised to the allometric power of 2.7 in Cox regression analysis, we observed a significant increased risk for patients having one marker above the threshold for all-cause and cardiovascular mortality [hazard ratio: 1.76; 95% confidence interval (1.08-2.86); 2.18 (1.06-4.46)] and for those having two markers above the threshold [2.76 (1.51-5.03); 3.90 (1.69-9.00)]. The prognostic value of the combination had the highest C-index (0.772 and 0.839, respectively) in comparison with LVMI (0.746 and 0.806, respectively).
Risk stratification in hypertension using the combination of NT-proBNP and RaVL is a simple method that may be considered in first line screening.
血浆 N 端脑利钠肽前体（NT-proBNP）和 aVL 导联 R 波（RaVL）与高血压患者的死亡率相关。本研究旨在比较其组合与超声心动图评估的左心室质量指数（LVMI）的预后价值。
共纳入 1104 例基线时评估血浆 NT-proBNP、12 导联心电图和超声心动图的高血压患者。921 例患者可评估 LVMI。中位（四分位间距）随访 8.5（5.4-13.3）年后，发生 110 例死亡，其中 62 例死于心血管原因。
RaVL 和血浆 NT-proBNP 预测死亡率的最佳阈值分别为 0.7mV 和 150pg/ml。基于 RaVL 和 NT-proBNP 构建了一个三模态变量：无一个以上阈值为 0，只有一个或两个以上阈值为 1 或 2。在校正包括 LVMI 的所有混杂因素后，LVMI 除以身高的幂次为 2.7，在 Cox 回归分析中，我们观察到一个标志物以上阈值的患者全因和心血管死亡率的风险显著增加[危险比：1.76；95%置信区间（1.08-2.86）；2.18（1.06-4.46）]，两个标志物以上阈值的患者[2.76（1.51-5.03）；3.90（1.69-9.00）]。与 LVMI 相比，组合的预测价值具有最高的 C 指数（分别为 0.772 和 0.839）。
使用 NT-proBNP 和 RaVL 组合对高血压进行风险分层是一种简单的方法，可在一线筛查中考虑。
