Garg Pankaj, Wood Steven, Swift Andrew J, Fent Graham, Lewis Nigel, Rogers Dominic, Rothman Alexander, Charalampopoulos Athanasios, Al-Mohammad Abdallah
Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK.
Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
ESC Heart Fail. 2020 Aug;7(4):1791-1800. doi: 10.1002/ehf2.12742. Epub 2020 Jun 4.
Clinical outcomes for patients suspected of having heart failure (HF) who do not meet the diagnostic criteria of any type of HF by echocardiography remain unknown. The aim of this study was to investigate the clinical predictors of all-cause mortality in patients with suspected HF, a raised N-terminal pro-b-type natriuretic peptide (NTproBNP) and who do not meet the diagnostic criteria of any type of HF by echocardiography.
Relevant data were taken from the Sheffield HEArt Failure (SHEAF) registry (222349P4). The inclusion criteria were presence of symptoms raising suspicion of HF, NTproBNP > 400 pg/mL, and preserved left ventricular function. Exclusion criteria were any type of HF by echocardiography. The outcome was defined as all-cause mortality. Cox proportional-hazards regression model was used to investigate the association between the survival time of patients and clinical variables; 1031 patients were identified with NTproBNP > 400 pg/mL but who did not have echocardiographic evidence of HF. All-cause mortality was 21.5% (222 deaths) over the mean follow-up (FU) period of 6 ± 2 years. NTproBNP was similar in patients who were alive or dead (P = 0.96). However, age (HR 1, P < 0.01), chronic kidney disease (CKD, HR 1.2, P < 0.01), chronic pulmonary obstructive disease (COPD, HR 1.6, P < 0.01), dementia (HR 5.9, P < 0.01), male gender (HR 1.4, P < 0.01), first-degree atrioventricular block (HR 2.1, P < 0.01), left axis deviation (HR 1.6, P = 0.04), and diabetes (HR 1.4, P = 0.03) were associated with all-cause mortality. In multivariate regression, age, gender, CKD stage, COPD, and dementia were independently associated with mortality. In patients with NTproBNP > 627 pg/mL, NYHA class predicted death (II, 19.6%; III, 27.4%; IV, 66.7%; P < 0.01).
Patients with no HF on echocardiography but raised NTproBNP suffer excess mortality particularly in the presence of certain clinical variables. Age, male gender, worsening CKD stage, presence of COPD, and dementia are independently associated with all-cause mortality in these patients. An NTproBNP > 627 pg/mL coupled with NYHA class could identify patients at greatest risk of death.
对于疑似心力衰竭（HF）但超声心动图未达到任何类型HF诊断标准的患者，其临床结局尚不清楚。本研究的目的是调查疑似HF、N末端B型利钠肽原（NTproBNP）升高且超声心动图未达到任何类型HF诊断标准的患者全因死亡的临床预测因素。
相关数据取自谢菲尔德心力衰竭（SHEAF）登记处（222349P4）。纳入标准为存在引起HF怀疑的症状、NTproBNP>400 pg/mL以及左心室功能保留。排除标准为超声心动图显示的任何类型HF。结局定义为全因死亡。采用Cox比例风险回归模型研究患者生存时间与临床变量之间的关联；确定1031例患者NTproBNP>400 pg/mL但无HF的超声心动图证据。在平均随访（FU）6±2年期间，全因死亡率为21.5%（222例死亡）。存活或死亡患者的NTproBNP相似（P = 0.96）。然而，年龄（HR 1，P < 0.01）、慢性肾脏病（CKD，HR 1.2，P < 0.01）、慢性阻塞性肺疾病（COPD，HR 1.6，P < 0.01）、痴呆（HR 5.9，P < 0.01）、男性（HR 1.4，P < 0.01）、一度房室传导阻滞（HR 2.1，P < 0.01）、电轴左偏（HR 1.6，P = 0.04）和糖尿病（HR 1.4，P = 0.03）与全因死亡相关。在多变量回归中，年龄、性别、CKD分期、COPD和痴呆与死亡率独立相关。在NTproBNP>627 pg/mL的患者中，纽约心脏病协会（NYHA）分级可预测死亡（II级，19.6%；III级，27.4%；IV级，66.7%；P < 0.01）。
超声心动图显示无HF但NTproBNP升高的患者死亡率过高，尤其是在存在某些临床变量的情况下。年龄、男性、CKD分期恶化、COPD的存在和痴呆与这些患者的全因死亡独立相关。NTproBNP>627 pg/mL加上NYHA分级可识别死亡风险最高的患者。
