Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
Akershus University Hospital, Lørenskog and University of Oslo, Oslo, Norway.
Eur J Heart Fail. 2022 Jul;24(7):1200-1208. doi: 10.1002/ejhf.2541. Epub 2022 May 30.
N-terminal pro-B-type natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT) and soluble ST2 (sST2) provide complementary prognostic information in heart failure with reduced ejection fraction (HFrEF). We aimed to assess the association between changes in these markers with changes in cardiac structure, function and health status.
Patients in the EVALUATE-HF trial (n = 464) were randomized to sacubitril/valsartan or enalapril for 12 weeks, followed by 12-week open-label sacubitril/valsartan. Cardiac biomarkers, echocardiography, and Kansas City Cardiomyopathy Questionnaires (KCCQ) were completed at baseline, and after 12 and 24 weeks. A total of 410 patients (88%) had serial biomarker measurements available (mean age 67 ± 9 years, 75% male and 75% white). After 24 weeks of treatment, NT-proBNP, sST2 and cTnT decreased by median (Q1, Q3) -31% (-55%, +6%), -6% (-19%, +8%) and - 3% (-13%, +8%), respectively (all p < 0.001). Decreases in NT-proBNP were associated with reductions in cardiac volumes and improvements in systolic and diastolic function and health status. Decreases in cTnT were associated with reductions in left ventricular mass, but not with changes in left ventricular function or KCCQ. Decreases in sST2 were consistently associated with improvements in health status, but not with measures of cardiac structure or function. There was no effect modification from treatment on the associations investigated (p for interaction >0.05) CONCLUSION: In HFrEF, serial changes in NT-proBNP correlate with changes in several key measures of cardiac structure and health status. cTnT changes correlate with changes in left ventricular mass and sST2 with changes in health status. These data highlight possible complementary pathophysiologic implications of changes in NT-proBNP, cTnT and sST2.
ClinicalTrials.gov Identifier: NCT02874794.
氨基末端 B 型利钠肽前体（NT-proBNP）、心肌肌钙蛋白 T（cTnT）和可溶性 ST2（sST2）在心衰射血分数降低（HFrEF）患者中提供了补充的预后信息。我们旨在评估这些标志物变化与心脏结构、功能和健康状况变化之间的关系。
EVALUATE-HF 试验（n=464）患者随机分为沙库巴曲缬沙坦或依那普利治疗 12 周，然后进行 12 周的沙库巴曲缬沙坦开放标签治疗。基线、12 周和 24 周时完成心脏生物标志物、超声心动图和堪萨斯城心肌病问卷（KCCQ）。共有 410 例患者（88%）有连续的生物标志物测量值（平均年龄 67±9 岁，75%为男性，75%为白人）。治疗 24 周后，NT-proBNP、sST2 和 cTnT 中位数（Q1，Q3）分别下降了 31%（-55%，+6%）、6%（-19%，+8%）和-3%（-13%，+8%）（均 p<0.001）。NT-proBNP 的降低与心脏容积的减少以及收缩和舒张功能及健康状况的改善相关。cTnT 的降低与左心室质量的减少相关，但与左心室功能或 KCCQ 无关。sST2 的降低与健康状况的改善始终相关，但与心脏结构或功能的测量值无关。在研究的相关性中，治疗无影响修饰作用（p 交互>0.05）。
在 HFrEF 中，NT-proBNP 的连续变化与心脏结构和健康状况的多个关键指标的变化相关。cTnT 的变化与左心室质量的变化相关，sST2 的变化与健康状况的变化相关。这些数据突出了 NT-proBNP、cTnT 和 sST2 变化的可能的补充病理生理意义。
ClinicalTrials.gov 标识符：NCT02874794。
