Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada.
Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada.
ESC Heart Fail. 2022 Feb;9(1):77-86. doi: 10.1002/ehf2.13692. Epub 2021 Nov 16.
N-terminal pro-b-type natriuretic peptide (NT-proBNP) values may be influenced by patient factors beyond the severity of illness, including atrial fibrillation (AF), renal dysfunction, or increased body mass index (BMI). We hypothesized that these factors may influence the achievement of NT-proBNP targets and clinical outcomes.
A total of 894 patients with heart failure with reduced ejection fraction were enrolled in The Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment trial. NT-proBNP was analysed every 3 months.
Forty per cent of patients had AF, the median estimated glomerular filtration rate (eGFR) was 59 mL/min/1.73 m [interquartile range (IQR) 43-76], and median BMI was 29 kg/m (IQR 25-34). Patients with AF, eGFR < 60 mL/min/1.73 m , or a BMI < 29 kg/m had a higher level of NT-proBNP at randomization and over all study visits (all P values < 0.001). Over 18 months, the rate of change of NT-proBNP was less for patients with AF (compared with those without AF, P = 0.037) and patients with an eGFR < 60 mL/min/1.73 m (compared with eGFR > 60 mL/min/1.73 m , P < 0.001). The rate of change of NT-proBNP was similar for patients with a BMI above or below the median value. Using the 90 day NT-proBNP, patients with AF, lower eGFR, or lower BMI were less likely to achieve the target NT-proBNP < 1000 pg/mL than patients without AF, higher eGFR, or higher BMI, respectively. None of these differed between the Usual Care or Guided Care arm for AF, eGFR, or BMI (P all NS).
Patients with AF, a lower BMI, or worse renal function are less likely to achieve a lower or target NT-proBNP. Clinicians should be aware of these factors both when interpreting NT-proBNP levels and making therapeutic decisions about heart failure therapies.
N 端脑利钠肽前体（NT-proBNP）值可能受到疾病严重程度以外的患者因素的影响，包括心房颤动（AF）、肾功能不全或体重指数（BMI）增加。我们假设这些因素可能影响 NT-proBNP 目标的实现和临床结局。
共有 894 例射血分数降低的心力衰竭患者参加了使用生物标志物强化治疗指导的循证治疗试验。每 3 个月分析一次 NT-proBNP。
40%的患者患有 AF，中位估算肾小球滤过率（eGFR）为 59 mL/min/1.73 m [四分位间距（IQR）43-76]，中位 BMI 为 29 kg/m（IQR 25-34）。AF、eGFR<60 mL/min/1.73 m 或 BMI<29 kg/m 的患者在随机分组和所有研究访视时 NT-proBNP 水平更高（所有 P 值均<0.001）。在 18 个月的时间里，AF 患者的 NT-proBNP 变化率较低（与无 AF 患者相比，P=0.037），eGFR<60 mL/min/1.73 m 的患者（与 eGFR>60 mL/min/1.73 m 的患者相比，P<0.001）。BMI 高于或低于中位数的患者 NT-proBNP 变化率相似。使用 90 天 NT-proBNP，AF、较低的 eGFR 或较低的 BMI 的患者与无 AF、较高的 eGFR 或较高的 BMI 的患者相比，更不可能达到目标 NT-proBNP<1000 pg/mL，分别。这些在 AF、eGFR 或 BMI 的常规护理或指导护理臂之间没有差异（所有 P 均 NS）。
患有 AF、较低 BMI 或更差肾功能的患者不太可能达到较低或目标 NT-proBNP。临床医生在解释 NT-proBNP 水平和做出心力衰竭治疗的治疗决策时都应注意这些因素。
