Department of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Int J Cardiol. 2022 Sep 15;363:163-170. doi: 10.1016/j.ijcard.2022.06.055. Epub 2022 Jun 23.
NT-pro B-type natriuretic peptide (NT-proBNP) is a powerful prognostic factor for acute heart failure. We investigated whether NT-proBNP levels differ based on the type of heart failure present.
Using the Korean Acute Heart Failure Registry, a prospective, multicenter cohort, we categorized patients into two groups: de novo heart failure (DNHF, n = 1617) and acute decompensated chronic heart failure (ADHF, n = 1212). NT-proBNP levels were measured on admission. The primary outcome was all-cause mortality, and the secondary outcomes were re-hospitalization for heart failure and a composite of all-cause mortality or re-hospitalization for heart failure at 90 days and 1 year.
NT-proBNP levels were significantly lower in patients with DNHF than in those with ADHF (median 4213 vs. 5523 ng/L, p < 0.001). Compared to patients with DNHF, patients with ADHF had a significantly worse prognosis for 1-year all-cause mortality (adjusted hazard ratio (HR) = 1.46 [95% confidence interval (CI) = 1.07-1.98], p = 0.017). A higher NT-proBNP level was associated with higher 1-year all-cause mortality for both heart failure types (adjusted HR = 2.00, p = 0.002 in ADHF; adjusted HR = 2.41, p = 0.003 in DNHF). However, all-cause mortality risk was always higher in patients with ADHF than in those with DNHF for any given NT-proBNP level.
NT-proBNP levels are an important prognostic factor for both DNHF and ADHF. Notably, patients with ADHF had consistently higher risks than those with DNHF with the same NT-proBNP level for 1-year all-cause mortality.
氨基末端 B 型利钠肽前体（NT-proBNP）是急性心力衰竭的一个强有力的预后因素。我们研究了 NT-proBNP 水平是否因心力衰竭类型不同而有所差异。
使用韩国急性心力衰竭注册研究，一项前瞻性、多中心队列研究，我们将患者分为两组：新发心力衰竭（DNHF，n=1617）和急性失代偿性慢性心力衰竭（ADHF，n=1212）。入院时测量 NT-proBNP 水平。主要结局是全因死亡率，次要结局是心力衰竭再住院率以及 90 天和 1 年时全因死亡率或心力衰竭再住院率的复合结局。
DNHF 患者的 NT-proBNP 水平明显低于 ADHF 患者（中位数 4213 vs. 5523ng/L，p<0.001）。与 DNHF 患者相比，ADHF 患者 1 年全因死亡率的预后明显更差（校正后风险比（HR）=1.46[95%置信区间（CI）=1.07-1.98]，p=0.017）。对于两种心力衰竭类型，较高的 NT-proBNP 水平均与 1 年全因死亡率增加相关（ADHF 中校正后 HR=2.00，p=0.002；DNHF 中校正后 HR=2.41，p=0.003）。然而，对于任何给定的 NT-proBNP 水平，ADHF 患者的全因死亡率风险始终高于 DNHF 患者。
NT-proBNP 水平是 DNHF 和 ADHF 的重要预后因素。值得注意的是，对于 1 年全因死亡率，ADHF 患者的风险始终高于 DNHF 患者，即使 NT-proBNP 水平相同。
