Oeun Bolrathanak, Nakatani Daisaku, Hikoso Shungo, Kojima Takayuki, Dohi Tomoharu, Kitamura Tetsuhisa, Okada Katsuki, Sunaga Akihiro, Kida Hirota, Yamada Takahisa, Uematsu Masaaki, Yasumura Yoshio, Higuchi Yoshiharu, Mano Toshiaki, Nagai Yoshiyuki, Fuji Hisakazu, Mizuno Hiroya, Sakata Yasushi
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Suita Japan.
Department of Environmental Medicine and Population Sciences, Osaka University Graduate School of Medicine Suita Japan.
Circ Rep. 2020 Jul 7;2(8):400-408. doi: 10.1253/circrep.CR-20-0051.
Little is known about factors associated with elevated N-terminal pro B-type natriuretic peptide (NT-proBNP) at the convalescent stage and their effects on 1-year outcomes in patients with heart failure with preserved ejection fraction (HFpEF). This study included 469 patients with HFpEF. Elevated NT-proBNP was defined as the highest quartile. The first 3 quartiles (Q1-Q3) were combined together for comparison with the fourth quartile (Q4). Median NT-proBNP concentrations in Q1-Q3 and Q4 were 669 and 3,504 pg/mL, respectively. Multivariate logistic regression analysis revealed that low albumin (odds ratio [OR] 2.44; 95% confidence interval [CI] 1.35-4.39; P=0.003), low estimated glomerular filtration rate (OR 5.83; 95% CI 3.46-9.83; P<0.001), high C-reactive protein (OR 2.09; 95% CI 1.21-3.63; P=0.009), and atrial fibrillation at discharge (OR 2.33; 95% CI 1.40-3.89; P=0.001) were associated with elevated NT-proBNP. Cumulative rates of all-cause mortality and heart failure rehospitalization were significantly higher in Q4 than in Q1-Q3 (P=0.001 and P<0.001, respectively). Incidence and hazard ratios of these adverse events increased when the number of associated factors for elevated NT-proBNP clustered together (P<0.001 and P=0.002, respectively). In addition to atrial fibrillation, extracardiac factors (malnutrition, renal impairment and inflammation) were associated with elevated NT-proBNP at the convalescent stage, and led to poor prognosis in patients with HFpEF.
关于射血分数保留的心力衰竭（HFpEF）患者恢复期N末端B型利钠肽原（NT-proBNP）升高的相关因素及其对1年预后的影响，目前所知甚少。本研究纳入了469例HFpEF患者。NT-proBNP升高定义为最高四分位数。将前3个四分位数（Q1-Q3）合并在一起与第四个四分位数（Q4）进行比较。Q1-Q3和Q4的NT-proBNP浓度中位数分别为669和3504 pg/mL。多因素logistic回归分析显示，低白蛋白（比值比[OR] 2.44；95%置信区间[CI] 1.35-4.39；P=0.003）、低估算肾小球滤过率（OR 5.83；95% CI 3.46-9.83；P<0.001）、高C反应蛋白（OR 2.09；95% CI 1.21-3.63；P=0.009）以及出院时房颤（OR 2.33；95% CI 1.40-3.89；P=0.001）与NT-proBNP升高相关。Q4全因死亡率和心力衰竭再住院的累积发生率显著高于Q1-Q3（分别为P=0.001和P<0.001）。当NT-proBNP升高的相关因素聚集在一起时，这些不良事件的发生率和风险比增加（分别为P<0.001和P=0.002）。除房颤外，心外因素（营养不良、肾功能损害和炎症）与恢复期NT-proBNP升高相关，并导致HFpEF患者预后不良。
