Massachusetts General Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
ESC Heart Fail. 2023 Oct;10(5):3133-3140. doi: 10.1002/ehf2.14503. Epub 2023 Aug 26.
Serial assessment of natriuretic peptides is widely utilized in heart failure clinics. Uncertainty exists regarding the value of multiple natriuretic peptide measurements and how they might be best interpreted.
Six hundred thirty-two patients with heart failure with reduced ejection fraction (<40%) and complete biomarker data were enrolled to receive sacubitril/valsartan. Patients underwent periodic study visits during 1-year follow-ups. Echocardiographic data and cardiac biomarkers, including N-terminal pro-B-type natriuretic peptide (NT-proBNP) were collected during study visits. Patients were categorized into three groups based on tertiles of baseline NT-proBNP levels. The area under the curve (AUC) of NT-proBNP measurements across study visits was calculated. Compared with patients with higher AUC (and thus higher concentrations over a longer period of time), those with lower AUC were younger, had a lower prevalence of chronic kidney disease, prior coronary artery bypass graft, atrial fibrillation, and higher body-mass index. A significant interaction existed between baseline NT-proBNP and subsequent AUC for predicting LVEF change across visits (P-value < 0.001): among those with lower baseline NT-proBNP, similar improvements in left ventricular (LV) volumes LV ejection fraction, and LV mass index were observed across subsequent AUC (P-value > 0.1). However, among those with higher baseline NT-proBNP, those with lower subsequent AUC had a greater improvement in cardiac remodelling indices (P-value < 0.05).
Serial NT-proBNP monitoring (integrating the totality of measurements as an AUC) during treatment with sacubitril/valsartan informs unique information regarding the future changes in cardiac remodelling indices, especially among those with higher NT-proBNP levels at baseline.
利钠肽的连续评估被广泛用于心力衰竭临床。对于多次利钠肽测量的价值以及如何最好地解释这些测量值，目前仍存在不确定性。
共纳入 632 例射血分数降低的心力衰竭（<40%）且具有完整生物标志物数据的患者，接受沙库巴曲缬沙坦治疗。患者在 1 年随访期间定期进行研究访视。在研究访视期间收集超声心动图数据和心脏生物标志物，包括氨基末端 B 型利钠肽前体（NT-proBNP）。根据基线 NT-proBNP 水平的三分位数，将患者分为三组。计算 NT-proBNP 测量值在研究访视期间的曲线下面积（AUC）。与 AUC 较高（因此在较长时间内浓度较高）的患者相比，AUC 较低的患者年龄较小，慢性肾脏病、先前的冠状动脉旁路移植术、心房颤动和较高的体重指数的患病率较低。基线 NT-proBNP 与随后的 AUC 之间存在显著的交互作用，用于预测整个访视期间 LVEF 的变化（P 值<0.001）：在基线 NT-proBNP 较低的患者中，随着随后的 AUC 的变化，左心室（LV）容积、LV 射血分数和 LV 质量指数的改善相似（P 值>0.1）。然而，在基线 NT-proBNP 较高的患者中，随后的 AUC 较低的患者心脏重塑指数的改善更大（P 值<0.05）。
在沙库巴曲缬沙坦治疗期间连续监测 NT-proBNP（整合所有测量值作为 AUC）可提供有关未来心脏重塑指数变化的独特信息，尤其是在基线 NT-proBNP 水平较高的患者中。
