Soler Meritxell, Miñana Gema, Santas Enrique, Núñez Eduardo, de la Espriella Rafael, Valero Ernesto, Bodí Vicente, Chorro Francisco J, Fernández-Cisnal Agustin, D'Ascoli Giulio, Marti-Cervera Jorge, Sanchis Juan, Bayes-Genís Antoni, Núñez Julio
Cardiology Department, Hospital Clínico Universitariom, Universitat de Valencia, INCLIVA, Valencia, Spain.
Cardiology Department, Hospital Clínico Universitariom, Universitat de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Spain.
Int J Cardiol. 2020 Jun 1;308:54-59. doi: 10.1016/j.ijcard.2020.03.027. Epub 2020 Mar 21.
In acute heart failure (AHF) with right ventricular dysfunction, the roles of amino-terminal pro-brain natriuretic peptide (NT-proBNP) and carbohydrate antigen 125 (CA125) are poorly understood, and functional tricuspid regurgitation (TR) severity is thought to indicate a poor prognosis. We examined the prognostic abilities of NT-proBNP and CA125 according to TR status among patients with AHF.
TR severity was assessed during index hospitalization (108 ± 24 h after admission) and classified as none/trivial, mild, moderate, or severe. Multivariable Cox regression analysis was performed to assess how pre-discharge CA125 and NT-proBNP were associated with long-term all-cause mortality relative to TR severity.
We prospectively included 2961 patients discharged following hospitalization for AHF (mean age 74 ± 11 years; 49.0% women; 51.8% with left ventricular ejection fraction >50%). Median NT-proBNP was 4823 ng/L (IQR: 2086-9183) and CA125 was 58.1 U/mL (IQR: 25-129). Severe TR was present in 300 patients (10.1%), and 1821 patients (61.5%) died (mean follow-up, 3.3 ± 3.2 years). Multivariate analysis revealed a differential prognostic effect across TR status for both biomarkers (p-value for both interactions<0.05). NT-proBNP was significantly linearly associated with mortality in non-severe TR (p < 0.001), but not in severe TR (p = 0.308). Higher CA125 values were significantly associated with mortality risk in all patients (HR: 1.09; 95% CI:1.03-1.14; p = 0.001), with a greater effect in those with severe TR (HR: 1.28; 98% CI:1.11-1.48; p = 0.001).
In patients with AHF and severe TR, CA125 outperforms NT-proBNP in predicting long-term mortality. In AHF with right ventricular involvement, CA125 may be the preferred biomarker for risk stratification.
在伴有右心室功能障碍的急性心力衰竭（AHF）中，氨基末端脑钠肽前体（NT-proBNP）和糖类抗原125（CA125）的作用尚不明确，且功能性三尖瓣反流（TR）的严重程度被认为预示着不良预后。我们研究了AHF患者中NT-proBNP和CA125根据TR状态的预后能力。
在首次住院期间（入院后108±24小时）评估TR严重程度，并分为无/微量、轻度、中度或重度。进行多变量Cox回归分析，以评估出院前CA125和NT-proBNP相对于TR严重程度与长期全因死亡率的关联。
我们前瞻性纳入了2961例因AHF住院后出院的患者（平均年龄74±11岁；49.0%为女性；51.8%左心室射血分数>50%）。NT-proBNP中位数为4823 ng/L（IQR：2086 - 9183），CA125为58.1 U/mL（IQR：25 - 129）。300例患者（10.1%）存在重度TR，1821例患者（61.5%）死亡（平均随访3.3±3.2年）。多变量分析显示，两种生物标志物在不同TR状态下具有不同的预后效应（两种相互作用的p值均<0.05）。NT-proBNP在非重度TR中与死亡率显著线性相关（p<0.001），但在重度TR中无相关性（p = 0.308）。较高的CA125值在所有患者中均与死亡风险显著相关（HR：1.09；95%CI：1.03 - 1.14；p = 0.001），在重度TR患者中影响更大（HR：1.28；98%CI：1.11 - 1.48；p = 0.001）。
在AHF和重度TR患者中，CA125在预测长期死亡率方面优于NT-proBNP。在伴有右心室受累的AHF中，CA125可能是风险分层的首选生物标志物。
