Department of Cardiovascular Sciences, University of Leicester, National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK.
Aintree University Hospital, Liverpool, UK.
ESC Heart Fail. 2021 Jun;8(3):2328-2333. doi: 10.1002/ehf2.13280. Epub 2021 Mar 10.
The aim of the study was to assess the association of P-selectin with outcomes in heart failure with preserved ejection fraction (HFpEF).
This is a prospective, observational study of 130 HFpEF patients who underwent clinical profiling, blood sampling, 6 min walk testing, Minnesota Living with Heart Failure Questionnaire evaluation, echocardiography, cardiovascular magnetic resonance imaging, calculation of the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk scores, and blinded plasma P-selectin measurement. Patients were followed up for the endpoint of all-cause mortality. The HFpEF subgroup with higher P-selectin levels [overall median 26 372, inter-quartile range (19 360-34 889) pg/mL] was associated with lower age, higher heart rate, less prevalent atrial fibrillation, more frequent current smoking status, and lower right ventricular end-diastolic volumes. During follow-up (median 1428 days), there were 38 deaths. Following maximal sensitivity and specificity receiver operating characteristic curve analysis, P-selectin levels above 35 506 pg/mL were associated with greater risk of all-cause mortality [hazard ratio (HR) 2.700; 95% confidence interval (CI) 1.416-5.146; log-rank P = 0.002]. Following multivariable Cox proportional hazards regression analysis and when added to MAGGIC scores, only P-selectin (adjusted HR 1.707; 95% CI 1.099-2.650; P < 0.017) and myocardial infarction detected by cardiovascular magnetic resonance imaging (HR 2.377; 95% CI 1.114-5.075; P < 0.025) remained significant predictors. In a final model comprising all three parameters, only P-selectin (HR 1.447; 95% CI 1.130-1.853; P < 0.003) and MAGGIC scores (HR 1.555; 95% CI 1.136-2.129; P < 0.006) remained independent predictors of death. Adding P-selectin (0.618, P = 0.035) improved the area under the receiver operating characteristic curve for mortality prediction for MAGGIC scores (0.647, P = 0.009) to 0.710, P < 0.0001.
Plasma P-selectin is an independent predictor of mortality and provides incremental prognostic information beyond MAGGIC scores in HFpEF.
本研究旨在评估 P-选择素与射血分数保留型心力衰竭（HFpEF）患者结局的相关性。
这是一项前瞻性、观察性研究，纳入了 130 例 HFpEF 患者，对其进行临床特征分析、采血、6 分钟步行试验、明尼苏达州心力衰竭生活质量问卷评估、超声心动图、心血管磁共振成像、Meta-Analysis Global Group in Chronic Heart Failure（MAGGIC）风险评分计算以及盲法检测血浆 P-选择素。患者接受了全因死亡率的随访。P-选择素水平较高的 HFpEF 亚组[总中位数 26372pg/ml（四分位距 19360-34889pg/ml）]与较低的年龄、较高的心率、较少发生心房颤动、较频繁的当前吸烟状态和较低的右心室舒张末期容积相关。在中位随访时间（1428 天）内，共有 38 例死亡。经最大灵敏度和特异性受试者工作特征曲线分析，P-选择素水平高于 35506pg/ml 与全因死亡率风险增加相关[风险比（HR）2.700；95%置信区间（CI）1.416-5.146；对数秩检验 P=0.002]。经多变量 Cox 比例风险回归分析，并且当加入 MAGGIC 评分后，仅 P-选择素（校正 HR 1.707；95%CI 1.099-2.650；P<0.017）和心血管磁共振成像检测到的心肌梗死（HR 2.377；95%CI 1.114-5.075；P<0.025）仍然是显著的预测因子。在包含所有三个参数的最终模型中，只有 P-选择素（HR 1.447；95%CI 1.130-1.853；P<0.003）和 MAGGIC 评分（HR 1.555；95%CI 1.136-2.129；P<0.006）仍然是死亡的独立预测因子。加入 P-选择素（0.618，P=0.035）可提高 MAGGIC 评分预测死亡率的受试者工作特征曲线下面积（从 0.647，P=0.009 至 0.710，P<0.0001）。
血浆 P-选择素是死亡率的独立预测因子，在 HFpEF 中提供了超越 MAGGIC 评分的额外预后信息。
