Cardiovascular Department, Papa Giovanni XXIII Hospital, Italy.
National Heart Centre Singapore, Duke-National University of Singapore, Singapore.
Eur J Prev Cardiol. 2021 Aug 9;28(9):937-945. doi: 10.1177/2047487319899618. Epub 2020 Feb 3.
Natriuretic peptides and diastolic dysfunction have prognostic value in asymptomatic subjects at risk for heart failure. Their integration might further refine the risk stratification process in this setting. Aim of this paper was to explore the possibility to predict heart failure and death combining diastolic dysfunction and natriuretic peptides in an asymptomatic population at risk for heart failure.
Among 4047 subjects aged ≥55/≤80 years followed by 10 general practitioners in Italy, the DAVID-Berg study prospectively enrolled 623 asymptomatic outpatients at increased risk for heart failure. Baseline evaluation included electrocardiogram, echocardiogram, and natriuretic peptides collection. Based on diastolic dysfunction and natriuretic peptides, subjects were classified in four groups: control group (no diastolic dysfunction/normal natriuretic peptides, 57%), no diastolic dysfunction/high natriuretic peptides (9%), diastolic dysfunction/normal natriuretic peptides (24%), and diastolic dysfunction/high natriuretic peptides (11%). We applied Cox multivariable and Classification and Regression Tree analyses.
The mean age of the population was 69 ± 7 years, 44% were women, mean left ventricular ejection fraction was 61%, and 35% had diastolic dysfunction. During a median follow-up of 5.7 years, 95 heart failure/death events occurred. Overall, diastolic dysfunction and natriuretic peptides were predictive of adverse events (respectively, hazard ratio 1.91, confidence interval 1.19-3.05, padjusted = 0.007, and hazard ratio 2.25, confidence interval 1.35-3.74, padjusted = 0.002) with Cox analysis. However, considering the four study subgroups, only the group with diastolic dysfunction/high natriuretic peptides had a significantly worse prognosis compared to the control group (hazard ratio 4.48, confidence interval 2.31-8.70, padjusted < 0.001). At Classification and Regression Tree analysis, diastolic dysfunction/high natriuretic peptides was the strongest prognostic factor (risk range 24-58%).
The DAVID-Berg data suggest that we look for the quite common combination of diastolic dysfunction/high natriuretic peptides to correctly identify asymptomatic subjects at greater risk for incident heart failure/death, thus more suitable for preventive interventions.
利钠肽和舒张功能障碍在心力衰竭风险无症状患者中有预后价值。将它们整合可能会进一步完善该环境下的风险分层过程。本文旨在探讨在心力衰竭风险无症状人群中，结合舒张功能障碍和利钠肽预测心力衰竭和死亡的可能性。
在意大利的 10 名全科医生随访的 4047 名年龄≥55/≤80 岁的患者中，DAVID-Berg 研究前瞻性地招募了 623 名无症状的心力衰竭高危门诊患者。基线评估包括心电图、超声心动图和利钠肽采集。根据舒张功能障碍和利钠肽，将患者分为四组：对照组（无舒张功能障碍/正常利钠肽，57%）、无舒张功能障碍/高利钠肽（9%）、舒张功能障碍/正常利钠肽（24%）和舒张功能障碍/高利钠肽（11%）。我们应用 Cox 多变量和分类回归树分析。
该人群的平均年龄为 69±7 岁，44%为女性，平均左心室射血分数为 61%，35%存在舒张功能障碍。在中位随访 5.7 年期间，共发生 95 例心力衰竭/死亡事件。总体而言，舒张功能障碍和利钠肽对不良事件有预测作用（分别为 Cox 分析中的危险比 1.91，置信区间 1.19-3.05，padjusted=0.007，危险比 2.25，置信区间 1.35-3.74，padjusted=0.002）。然而，考虑到四个研究亚组，只有舒张功能障碍/高利钠肽组与对照组相比，预后明显较差（危险比 4.48，置信区间 2.31-8.70，padjusted<0.001）。在分类回归树分析中，舒张功能障碍/高利钠肽是最强的预后因素（风险范围 24%-58%）。
DAVID-Berg 数据表明，我们寻找舒张功能障碍/高利钠肽的常见组合，以正确识别心力衰竭/死亡风险较高的无症状患者，从而更适合预防干预。
