Cardiology Department, Universitat de Valencia, Spain.
Centro de Investigación Biomédica en Red Cardiovascular, Spain.
Eur Heart J Acute Cardiovasc Care. 2020 Aug;9(5):437-447. doi: 10.1177/2048872620908033. Epub 2020 Mar 4.
Plasma amino-terminal pro-B-type natriuretic peptide and antigen carbohydrate 125 levels are positively associated with a higher risk of adverse clinical outcomes in acute heart failure. As a proxy of congestion, antigen carbohydrate 125 has also been proposed as a right-sided heart failure marker. Thus, we aimed to determine in this population the main factors - including echocardiographic right-sided heart failure parameters - associated with antigen carbohydrate 125 and amino-terminal pro-B-type natriuretic peptide.
We prospectively included 2949 patients admitted with acute heart failure. Amino-terminal pro-B-type natriuretic peptide and antigen carbohydrate 125 were used as dependent variables in a multivariable linear regression analysis. The mean age of the sample was 73.9±11.1 years; 48.9% were female, 35.8% showed ischaemic aetiology, and 51.6% exhibited heart failure with preserved ejection fraction. The median (interquartile range) for amino-terminal pro-B-type natriuretic peptide and antigen carbohydrate 125 were 4840 (2111-9204) pg/ml and 58 (26-129) U/ml, respectively. In a multivariable setting, and ranked in order of importance (R), estimated glomerular filtration rate (43.7%), left ventricle ejection fraction (15.1%), age (12.4%) and high-sensitivity troponin T (10.9%) emerged as the most important factors associated with amino-terminal pro-B-type natriuretic peptide. The five main factors associated with antigen carbohydrate 125 were, in order of importance: the presence of pleural effusion (36.8%), tricuspid regurgitation severity (25.1%), age (11.9%), amino-terminal pro-B-type natriuretic peptide (6.5%) and peripheral oedema (4.3%).
In patients with acute heart failure the main factors associated with amino-terminal pro-B-type natriuretic peptide were renal dysfunction, left ventricle ejection fraction and age. For antigen carbohydrate 125, clinical parameters of congestion and the severity of tricuspid regurgitation were the most important predictors. These results endorse the value of antigen carbohydrate 125 as a useful marker of right-sided heart failure.
血浆氨基末端 B 型利钠肽原和抗原碳水化合物 125 水平与急性心力衰竭不良临床结局的风险增加呈正相关。作为充血的替代物，抗原碳水化合物 125 也被提议作为右心衰竭标志物。因此，我们旨在确定在该人群中，与抗原碳水化合物 125 和氨基末端 B 型利钠肽原相关的主要因素 - 包括超声心动图右心衰竭参数。
我们前瞻性纳入了 2949 例因急性心力衰竭入院的患者。氨基末端 B 型利钠肽原和抗原碳水化合物 125 作为多元线性回归分析中的因变量。样本的平均年龄为 73.9±11.1 岁；48.9%为女性，35.8%为缺血性病因，51.6%为射血分数保留的心力衰竭。氨基末端 B 型利钠肽原和抗原碳水化合物 125 的中位数（四分位距）分别为 4840（2111-9204）pg/ml 和 58（26-129）U/ml。在多变量环境中，按照重要性排序（R），估计肾小球滤过率（43.7%）、左心室射血分数（15.1%）、年龄（12.4%）和高敏肌钙蛋白 T（10.9%）是与氨基末端 B 型利钠肽原相关的最重要因素。与抗原碳水化合物 125 相关的五个主要因素按重要性依次为：胸腔积液存在（36.8%）、三尖瓣反流严重程度（25.1%）、年龄（11.9%）、氨基末端 B 型利钠肽原（6.5%）和外周水肿（4.3%）。
在急性心力衰竭患者中，与氨基末端 B 型利钠肽原相关的主要因素是肾功能障碍、左心室射血分数和年龄。对于抗原碳水化合物 125，充血的临床参数和三尖瓣反流的严重程度是最重要的预测因素。这些结果支持抗原碳水化合物 125 作为右心衰竭有用标志物的价值。
