Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Avda. Blasco Ibáñez 17, Valencia 46010, Spain.
Nephrology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Avda. Blasco Ibáñez 17, Valencia 46010, Spain.
Eur Heart J Acute Cardiovasc Care. 2021 Jun 30;10(5):475-483. doi: 10.1093/ehjacc/zuab022.
Intrarenal venous flow (IRVF) measured by Doppler ultrasound has gained interest as a potential surrogate marker of renal congestion and adverse outcomes in heart failure. In this work, we aimed to determine if antigen carbohydrate 125 (CA125) and plasma amino-terminal pro-B-type natriuretic peptide (NT-proBNP) are associated with congestive IRVF patterns (i.e., biphasic and monophasic) in acute heart failure (AHF).
We prospectively enrolled a consecutive cohort of 70 patients hospitalized for AHF. Renal Doppler ultrasound was assessed within the first 24-h of hospital admission. The mean age of the sample was 73.5 ± 12.3 years; 47.1% were female, and 42.9% exhibited heart failure with preserved ejection fraction. The median (interquartile range) for NT-proBNP and CA125 were 6149 (3604-12 330) pg/mL and 64 (37-122) U/mL, respectively. The diagnostic performance of both exposures for identifying congestive IRVF patterns was tested using the receiving operating curve (ROC). The cut-off for CA125 of 63.5 U/mL showed a sensibility and specificity of 67% and 74% and an area under the ROC curve of 0.71. After multivariate adjustment, CA125 remained non-linearly and positively associated with congestive IRVF (P-value = 0.008) and emerged as the most important covariate explaining the variability of the model (R2: 47.5%). Under the same multivariate setting, NT-proBNP did not show to be associated with congestive IRVF patterns (P-value = 0.847).
CA125 and not NT-proBNP is a useful marker for identifying patients with AHF and congestive IRVF patterns.
通过多普勒超声测量的肾内静脉血流（IRVF）作为心力衰竭时肾脏淤血和不良结局的潜在替代标志物引起了关注。在这项工作中，我们旨在确定抗原碳水化合物 125（CA125）和血浆氨基末端 pro-B 型利钠肽（NT-proBNP）是否与充血性 IRVF 模式（即双相和单相）相关在急性心力衰竭（AHF）中。
我们前瞻性纳入了因 AHF 住院的连续队列的 70 名患者。在入院后的头 24 小时内评估肾脏多普勒超声。样本的平均年龄为 73.5±12.3 岁；47.1%为女性，42.9%表现为射血分数保留的心力衰竭。NT-proBNP 和 CA125 的中位数（四分位距）分别为 6149（3604-12330）pg/ml 和 64（37-122）U/ml。使用接收者操作曲线（ROC）测试了这两种暴露因素识别充血性 IRVF 模式的诊断性能。CA125 的截断值为 63.5U/ml，其敏感性和特异性分别为 67%和 74%，ROC 曲线下面积为 0.71。经过多变量调整后，CA125 与充血性 IRVF 呈非线性正相关（P 值=0.008），并且是解释模型变异性的最重要协变量（R2：47.5%）。在相同的多变量环境下，NT-proBNP 与充血性 IRVF 模式无关（P 值=0.847）。
CA125 而不是 NT-proBNP 是识别 AHF 患者和充血性 IRVF 模式的有用标志物。
