Pastore Maria Concetta, Mandoli Giulia Elena, Stefanini Andrea, Ghionzoli Nicolò, Carrucola Chiara, De Carli Giuseppe, Lisi Matteo, Cavigli Luna, D'Ascenzi Flavio, Focardi Marta, Valente Serafina, Patti Giuseppe, Mondillo Sergio, Cameli Matteo
Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy; Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy.
Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
Int J Cardiol. 2023 Jan 15;371:266-272. doi: 10.1016/j.ijcard.2022.08.056. Epub 2022 Sep 5.
The relief of congestion is crucial to improve heart failure (HF) patient's quality of life and prognosis. N-terminal-pro-brain natriuretic peptide (NT-proBNP) is a well-known marker of congestion, although with limited specificity. Peak atrial longitudinal strain (PALS) by speckle tracking echocardiography (STE) is an index of intracardiac pressure and HF prognosis. We aimed to determine the association between NT-proBNP and PALS and its prognostic implications in patients with HF.
Patients hospitalized for de-novo or recurrent HF and outpatients with chronic HF were included in this retrospective study. Patients with missing data, previous cardiac surgery, non-feasible STE were excluded. Clinical, laboratory and echocardiographic data were collected. STE was performed on echocardiographic records. Primary endpoint was a combination of all-cause death and HF hospitalization.
Overall, 388 patients were included (172 acute HF, 216 chronic HF, mean age = 65 ± 12 years, 37% female). Mean LV ejection fraction = 31 ± 9%. Global PALS showed a significant inverse correlation with NT-proBNP in acute and chronic HF (all p < 0.001). During a median follow-up of 4 years, 180 patients reached the combined endpoint. NT-proBNP (AUC = 0.87) and global PALS (AUC = 0.82) were good predictors of the combined endpoint. Global PALS was the only independent predictor of the combined endpoint. Optimal risk stratification for the composite endpoint was provided combining PALS ≤15% and NTproBNP ≥874.5 ng/l.
Global PALS is associated with NT-proBNP in acute and chronic HF and may be used as additional index of congestion to optimize therapeutic management. The combination of global PALS and NT-proBNP could enhance the prognostic stratification of HF.
缓解充血对于改善心力衰竭（HF）患者的生活质量和预后至关重要。N末端脑钠肽前体（NT-proBNP）是一种众所周知的充血标志物，但其特异性有限。斑点追踪超声心动图（STE）测量的心房纵向应变峰值（PALS）是心内压力和HF预后的一个指标。我们旨在确定NT-proBNP与PALS之间的关联及其对HF患者的预后意义。
本回顾性研究纳入了因新发或复发HF住院的患者以及慢性HF门诊患者。排除有缺失数据、既往心脏手术史、无法进行STE的患者。收集临床、实验室和超声心动图数据。在超声心动图记录上进行STE检查。主要终点是全因死亡和HF住院的联合终点。
总共纳入了388例患者（172例急性HF，216例慢性HF，平均年龄 = 65 ± 12岁，37%为女性）。平均左心室射血分数 = 31 ± 9%。在急性和慢性HF中，整体PALS与NT-proBNP呈显著负相关（所有p < 0.001）。在中位随访4年期间，180例患者达到联合终点。NT-proBNP（AUC = 0.87）和整体PALS（AUC = 0.82）是联合终点的良好预测指标。整体PALS是联合终点的唯一独立预测指标。结合PALS≤15%和NT-proBNP≥874.5 ng/l可对复合终点进行最佳风险分层。
在急性和慢性HF中，整体PALS与NT-proBNP相关，可作为优化治疗管理的额外充血指标。整体PALS和NT-proBNP的联合应用可增强HF的预后分层。
