N末端B型利钠肽原与围产期心肌病无事件生存及左心室收缩功能恢复的预测因素
NT-proBNP and predictors of event free survival and left ventricular systolic function recovery in peripartum cardiomyopathy.
作者信息
Imran Tasnim F, Mohebali Donya, Lopez Diana, Goli Rahul R, DeFilippis Ersilia M, Truong Sandy, Bello Natalie A, Gaziano J Michael, Djousse Luc, Coglianese Erin E, Feinberg Loryn, Wu Wen-Chih, Choudhary Gaurav, Arany Zoltan, Kociol Robb, Sabe Marwa A
机构信息
Warren Alpert Medical School of Brown University, Section of Cardiology, Rhode Island and Miriam Hospitals, and Providence VA Medical Center, Providence, RI 02809, USA; Department of Medicine, Division of Aging, Brigham and Women's Hospital and the VA Boston Healthcare System, Harvard Medical School, Boston, MA 02120, USA.
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
出版信息
Int J Cardiol. 2022 Jun 15;357:48-54. doi: 10.1016/j.ijcard.2022.03.052. Epub 2022 Mar 28.
OBJECTIVE
To determine predictors of adverse outcomes in peripartum cardiomyopathy (PPCM).
METHODS AND RESULTS
We conducted a multi-center cohort study across four centers to identify subjects with PPCM with the following criteria: LVEF <40%, development of heart failure within the last month of pregnancy or within 5 months of delivery and no other identifiable cause of heart failure with reduced ejection fraction. Outcomes included 1) survival free from major adverse events (need for extra-corporeal membrane oxygenation, ventricular assist device, orthotopic heart transplantation or death) and 2) LVEF recovery ≥ 50%. Using a univariate logistic regression analysis, we identified significant clinical predictors of these outcomes, which were then used to create multivariable models. NT-proBNP at the time of diagnosis was examined both as a continuous variable (log transformed) in logistic regression and as a dichotomous variable (values above and below the median) using the log-rank test. In all, 237 women (1993 to 2017) with 736.4 person-years of follow-up, met criteria for PPCM. Participants had a mean age of 32.4 ± 6.7 years, mean BMI 30.6 ± 7.8 kg/m2; 63% were White. After median follow-up of 3.6 years (IQR 1.1-7.8), 113 (67%) had LVEF recovery, and 222 (94%) had survival free from adverse events. Significant predictors included gestational age, gravidity, systolic blood pressure, smoking, heart rate, initial LVEF, and diuretic use. In a subset of 110 patients with measured NTproBNP levels, we found a higher event free survival for women with NTproBNP <2585 pg/ml (median) as compared to women with NTproBNP ≥2585 pg/ml (log-rank test p-value 0.018).
CONCLUSION
Gestational age, gravidity, current or past tobacco use, systolic blood pressure, heart rate, initial LVEF and diuretic requirement at the time of diagnosis were associated with survival free from adverse events and LVEF recovery. Initial NT-proBNP was significantly associated with event free survival.
目的
确定围产期心肌病（PPCM）不良结局的预测因素。
方法与结果
我们在四个中心开展了一项多中心队列研究，以确定符合以下标准的PPCM患者：左心室射血分数（LVEF）<40%，在妊娠最后1个月内或分娩后5个月内发生心力衰竭，且无其他可识别的射血分数降低的心力衰竭病因。结局包括：1）无主要不良事件（需要体外膜肺氧合、心室辅助装置、原位心脏移植或死亡）存活；2）LVEF恢复≥50%。通过单因素逻辑回归分析，我们确定了这些结局的显著临床预测因素，然后用于建立多变量模型。诊断时的N末端B型利钠肽原（NT-proBNP）在逻辑回归中作为连续变量（对数转换）进行检验，并使用对数秩检验作为二分变量（中位数上下的值）进行检验。共有237名女性（1993年至2017年）符合PPCM标准，随访736.4人年。参与者的平均年龄为32.4±6.7岁，平均体重指数为30.6±7.8kg/m²；63%为白人。中位随访3.6年（四分位间距1.1 - 7.8年）后，113例（67%）LVEF恢复，222例（94%）无不良事件存活。显著的预测因素包括孕周、妊娠次数、收缩压、吸烟、心率、初始LVEF和利尿剂使用情况。在110例测量了NT-proBNP水平的患者亚组中，我们发现NT-proBNP<2585pg/ml（中位数）的女性与NT-proBNP≥2585pg/ml的女性相比，无事件生存期更长（对数秩检验p值为0.018）。
结论
孕周、妊娠次数、当前或既往吸烟情况、收缩压、心率、诊断时初始LVEF和利尿剂需求与无不良事件存活及LVEF恢复相关。初始NT-proBNP与无事件生存期显著相关。
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