Division of Cardiology, Medical University of Vienna, Vienna, Austria.
Vienna Healthcare Group, Vienna, Austria.
ESC Heart Fail. 2022 Aug;9(4):2367-2377. doi: 10.1002/ehf2.13930. Epub 2022 May 20.
We aim to explore the relationship of heart failure (HF) and diabetes with cardiovascular (CV) death or hospitalization for HF (HHF) and to study the clinical utility of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in an unselected patient population with atrial fibrillation (AF).
Patients with AF admitted to a tertiary academic center between January 2005 and July 2019 were identified through a search of electronic health records. We used Cox regression models adjusted for age, sex, estimated glomerular filtration rate, diabetes, HF, body mass index, prior myocardial infarction, coronary artery disease, hypertension, smoking, C-reactive protein, and low-density lipoprotein cholesterol. To select the most informative variables, we performed a least absolute shrinkage and selection operator Cox regression with 10-fold cross-validation. In total, 7412 patients (median age 70 years, 39.7% female) were included in this analysis and followed over a median of 4.5 years. Both diabetes [adjusted (Adj.) HR 1.87, 95% CI 1.55-2.25] and HF (Adj. HR 2.57, 95% CI 2.22-2.98) were significantly associated with CV death/HHF after multivariable adjustment. Compared with patients with diabetes, HF patients had a higher risk of HHF but a similar risk of CV and all-cause death. NT-proBNP showed good discriminatory performance (area under the curve 0.78, 95% CI 0.77-0.80) and the addition of NT-proBNP to the covariates used for adjustment resulted in a significant area under the curve improvement (Δ = 0.04, P < 0.001). With least absolute shrinkage and selection operator, the strongest associations for CV death/HHF were obtained for NT-proBNP [HR 1.91 per 1-SD in log-transformed biomarker], HF (HR 1.72), and diabetes (HR 1.56).
Diabetes and HF were independently associated with an increased risk of CV death/HHF in an unselected AF patient population, and NT-proBNP improved risk assessment. These findings suggest that AF patients with diabetes and/or HF should be managed not only for their risk of stroke and systemic embolic events but also for CV death/HHF.
本研究旨在探讨心力衰竭（HF）和糖尿病与心血管（CV）死亡或因心力衰竭住院（HHF）的关系，并研究 N 末端脑利钠肽前体（NT-proBNP）在未经选择的伴有心房颤动（AF）的患者人群中的临床应用价值。
通过电子病历搜索，确定了 2005 年 1 月至 2019 年 7 月期间在一家三级学术中心住院的 AF 患者。我们使用 Cox 回归模型，对年龄、性别、估算肾小球滤过率、糖尿病、HF、体重指数、既往心肌梗死、冠心病、高血压、吸烟、C 反应蛋白和低密度脂蛋白胆固醇进行了调整。为了选择最具信息量的变量，我们进行了带有 10 倍交叉验证的最小绝对收缩和选择算子 Cox 回归。共纳入 7412 例患者（中位年龄 70 岁，39.7%为女性），中位随访时间为 4.5 年。多变量调整后，糖尿病[调整后（Adj.）HR 1.87，95%置信区间（CI）1.55-2.25]和 HF（Adj. HR 2.57，95% CI 2.22-2.98）均与 CV 死亡/HHF 显著相关。与糖尿病患者相比，HF 患者发生 HHF 的风险更高，但 CV 和全因死亡的风险相似。NT-proBNP 显示出良好的区分性能（曲线下面积 0.78，95% CI 0.77-0.80），将 NT-proBNP 添加到用于调整的协变量中可显著提高曲线下面积（Δ=0.04，P<0.001）。使用最小绝对收缩和选择算子，与 CV 死亡/HHF 最强相关的因素为 NT-proBNP[每 1-SD 对数转化生物标志物增加 1.91 的 HR]、HF（HR 1.72）和糖尿病（HR 1.56）。
在未经选择的 AF 患者人群中，糖尿病和 HF 独立与 CV 死亡/HHF 风险增加相关，NT-proBNP 可改善风险评估。这些发现表明，患有糖尿病和/或 HF 的 AF 患者不仅应针对其发生卒中及全身性栓塞事件的风险进行管理，还应针对其 CV 死亡/HHF 风险进行管理。
