Unurjargal Ts, Khorloo Ch, Ulziisaikhan G, Sodovsuren N, Khasag A
Mongolian National University of Medical Sciences.
Cardiovascular center, Third State Central Hospital.
Kardiologiia. 2020 Mar 27;60(4):86-90. doi: 10.18087/cardio.2020.4.n788.
Objective The goals of the present study were to assess the prevalence of asymptomatic heart failure with preserved ejection fraction (HFpEF) in subjects at high risk of developing HF and to define the diagnostic accuracy of NT-pro BNP assay compared with echocardiography in this setting.Material and methods This cross-sectional study included subjects aged from 35 to 64 years, with high risk of HF, who had no clinical symptoms of HF. Risk factors of HF were detected by clinical examinations. NT-pro BNP determination was performed using immunoassay analyzer (FIA8000, Getein Bio Medical Inc, China),. The cut-off point for NT-pro BNP was 125 pg/ml. Diagnosis of HFpEF was based on criteria recommended by 2016 ESC heart failure guidelines. Diastolic dysfunction was assessed according to the algorithm proposed in the joint recommendations of the ASE/EACVI.Results 602 patients with risk factors of HF were included in the study, of which 256 (42.5 %) were males and 346 (57.5 %) females. The mean age was 51.71±8.07 years. 83 patients (13.8 %) showed elevated NT-pro BNP levels of ≥125 pg / ml. Our study has shown that NT-pro BNP concentration was positively correlating with age, both systolic and diastolic blood pressure, left ventricular mass and E / e' ratio and negatively correlating with waist circumference, body mass index, left ventricular EF and E / A ratio in asymptomatic population. The likelihood of positive NT-pro BNP test was independently (p<0.05) associated with age, hypertension and diabetes. The diagnosis of asymptomatic HFpEF was confirmed in 12.3 % of studied population. A cutoff value of 125 pg / ml for NT-proBNP concentration showed the following diagnostic re-abilities in identifying asymptomatic HFpEF: sensitivity 85.0 %, specificity 88.6 % and area under curve 0.92 (95 % CI 0.86-0.98).Conclusion Subjects with raised NT-pro BNP level (≥125 pg/ml) were more likely to have a confirmed diagnosis of asymptomatic HFpEF after screening. In summary, in at-risk population, natriuretic peptide based screening combined with echocardiography identifies high prevalence of asymptomatic HFpEF.
目的 本研究的目的是评估射血分数保留的无症状心力衰竭（HFpEF）在有发生心力衰竭高风险受试者中的患病率，并确定在这种情况下与超声心动图相比，N末端B型利钠肽原（NT-pro BNP）检测的诊断准确性。
材料和方法 这项横断面研究纳入了年龄在35至64岁、有心力衰竭高风险且无心力衰竭临床症状的受试者。通过临床检查检测心力衰竭的危险因素。使用免疫分析分析仪（FIA8000，中国基蛋生物科技股份有限公司）进行NT-pro BNP测定。NT-pro BNP的截断值为125 pg/ml。HFpEF的诊断基于2016年欧洲心脏病学会（ESC）心力衰竭指南推荐的标准。根据美国超声心动图学会（ASE）/欧洲心血管影像学会（EACVI）联合推荐中提出的算法评估舒张功能障碍。
结果 602例有心力衰竭危险因素的患者纳入本研究，其中男性256例（42.5%），女性346例（57.5%）。平均年龄为51.71±8.07岁。83例患者（13.8%）NT-pro BNP水平升高≥125 pg/ml。我们的研究表明，在无症状人群中，NT-pro BNP浓度与年龄、收缩压和舒张压、左心室质量以及E/e'比值呈正相关，与腰围、体重指数、左心室射血分数（EF）和E/A比值呈负相关。NT-pro BNP检测阳性的可能性与年龄、高血压和糖尿病独立相关（p<0.05）。在12.3%的研究人群中确诊为无症状HFpEF。NT-pro BNP浓度截断值为125 pg/ml时，在识别无症状HFpEF方面显示出以下诊断能力：敏感性85.0%，特异性8**8.6%，曲线下面积0.92（95%可信区间0.86 - 0.98）。
结论 NT-pro BNP水平升高（≥125 pg/ml）的受试者在筛查后更有可能被确诊为无症状HFpEF。总之，在高危人群中，基于利钠肽的筛查联合超声心动图可发现无症状HFpEF的高患病率。
