Yu Yu, Huang Hao, Cheng Sijing, Deng Yu, Liu Xi, Gu Min, Chen Xuhua, Niu Hongxia, Cai Chi, Hua Wei
State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2022 Jul 22;9:941709. doi: 10.3389/fcvm.2022.941709. eCollection 2022.
Elevated levels of N-terminal pro-B natriuretic peptide (NT-proBNP) and left ventricular hypertrophy (LVH) are independent risk factors for heart failure (HF). In addition, right ventricular pacing (RVP) is an effective treatment strategy for bradyarrhythmia, but long-term RVP is associated with HF. However, there is limited evidence on the independent and combined association of NT-proBNP and left ventricular mass index (LVMI) with HF risk in elderly diabetic patients with long-term RVP.
Between January 2017 and January 2018, a total of 224 elderly diabetic patients with RVP at Fuwai Hospital were consecutively included in the study, with a 5-year follow-up period. The study endpoint was the first HF readmission during follow-up. This study aimed to explore the independent and joint relationship of NT-proBNP and LVMI with HF readmission in elderly diabetic patients with long-term RVP, using a multivariate Cox proportional hazards regression model.
A total of 224 (11.56%) elderly diabetic patients with RVP were included in the study. During the 5-year follow-up period, a total of 46 (20.54%) patients suffered HF readmission events. Multivariate Cox proportional hazards regression analysis showed that higher levels of NT-proBNP and LVMI were independent risk factors for HF readmission [NT-proBNP: hazard risk (HR) = 1.05, 95% confidence interval (CI): 1.01-1.10; LVMI: HR = 1.14, 95% CI: 1.02-1.27]. The optimal cut-off point of NT-proBNP was determined to be 330 pg/ml by receiver operating characteristic (ROC) curve analysis. Patients with NT-proBNP > 330 pg/ml and LVH had a higher risk of HF readmission compared to those with NT-proBNP ≤ 330 pg/ml and non-LVH (39.02% vs. 6.17%; HR = 7.72, 95% CI: 1.34-9.31, < 0.001).
In elderly diabetic patients with long-term RVP, NT-proBNP and LVMI were associated with the risk of HF readmission. Elevated NT-proBNP combined with LVH resulted in a significantly higher risk of HF readmission.
N 末端 B 型利钠肽原（NT-proBNP）水平升高和左心室肥厚（LVH）是心力衰竭（HF）的独立危险因素。此外，右心室起搏（RVP）是治疗缓慢性心律失常的有效策略，但长期 RVP 与 HF 相关。然而，关于 NT-proBNP 和左心室质量指数（LVMI）与长期 RVP 的老年糖尿病患者 HF 风险的独立及联合关联的证据有限。
2017 年 1 月至 2018 年 1 月期间，共有 224 例在阜外医院接受 RVP 的老年糖尿病患者连续纳入本研究，随访期为 5 年。研究终点是随访期间首次因 HF 再次入院。本研究旨在使用多变量 Cox 比例风险回归模型探讨 NT-proBNP 和 LVMI 与长期 RVP 的老年糖尿病患者 HF 再次入院的独立及联合关系。
本研究共纳入 224 例（11.56%）接受 RVP 的老年糖尿病患者。在 5 年随访期内，共有 46 例（20.54%）患者发生 HF 再次入院事件。多变量 Cox 比例风险回归分析显示，NT-proBNP 和 LVMI 水平较高是 HF 再次入院的独立危险因素[NT-proBNP：风险比（HR）=1.05，95%置信区间（CI）：1.01 - 1.10；LVMI：HR = 1.14，95%CI：1.02 - 1.27]。通过受试者工作特征（ROC）曲线分析确定 NT-proBNP 的最佳截断点为 330 pg/ml。与 NT-proBNP≤330 pg/ml 且无 LVH 的患者相比，NT-proBNP>330 pg/ml 且有 LVH 的患者 HF 再次入院风险更高（39.02%对 6.17%；HR = 7.72，95%CI：1.34 - 9.31，P<0.001）。
在长期 RVP 的老年糖尿病患者中，NT-proBNP 和 LVMI 与 HF 再次入院风险相关。NT-proBNP 升高合并 LVH 导致 HF 再次入院风险显著更高。
