Appleby Sarah, Frampton Chris, Holdaway Mark, Chew-Harris Janice, Liew Oi Wah, Chong Jenny Pek Ching, Lewis Lynley, Troughton Richard, Ooi Shirley Beng Suat, Kuan Win Sen, Ibrahim Irwani, Chan Siew Pang, Richards A Mark, Pemberton Christopher J
Department of Medicine, Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand.
Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand.
Front Cardiovasc Med. 2024 Jan 8;10:1195082. doi: 10.3389/fcvm.2023.1195082. eCollection 2023.
In dyspneic patients with atrial fibrillation (AF) or obesity, the diagnostic performance of NT-proBNP for acute heart failure is reduced. We evaluated the erythroblast derived protein erythroferrone (ERFE) as an ancillary biomarker for the diagnosis of acute decompensated heart failure (ADHF) in these comorbid subgroups in both Western and Asian populations.
The diagnostic performance of ERFE (Intrinsic Lifesciences) and NT-proBNP (Roche Cobas e411) for ADHF was assessed in 479 New Zealand (NZ) and 475 Singapore (SG) patients presenting with breathlessness.
Plasma ERFE was higher in ADHF, compared with breathlessness from other causes, in both countries (NZ; 4.9 vs. 1.4 ng/ml, < 0.001) and (SG; 4.2 vs. 0.4 ng/ml, = 0.021). The receiver operating characteristic (ROC) areas under the curve (AUCs) for discrimination of ADHF were reduced in the NZ cohort compared to SG for ERFE (0.75 and 0.84, = 0.007) and NT-proBNP (0.86 and 0.92, = 0.004). Optimal cut-off points for ERFE yielded comparable sensitivity and positive predictive values in both cohorts, but slightly better specificity, negative predictive values and accuracy in SG compared with NZ. In patients with AF, the AUC decreased for ERFE in each cohort (NZ: 0.71, = 105, SG: 0.61, = 44) but increased in patients with obesity (NZ: 0.79, = 150, SG: 0.87, = 164).
Circulating ERFE is higher in patients with ADHF than in other causes of new onset breathlessness with fair diagnostic utility, performing better in Asian than in Western patients. The diagnostic performance of ERFE is impaired in patients with AF but not patients with obesity.
在伴有心房颤动（AF）或肥胖的呼吸困难患者中，N末端B型利钠肽原（NT-proBNP）对急性心力衰竭的诊断效能降低。我们评估了成红细胞衍生蛋白红系铁调素（ERFE）作为辅助生物标志物在西方和亚洲人群中这些合并症亚组中诊断急性失代偿性心力衰竭（ADHF）的作用。
在479名新西兰（NZ）和475名新加坡（SG）因气促就诊的患者中评估ERFE（Intrinsic Lifesciences公司）和NT-proBNP（罗氏Cobas e411）对ADHF的诊断效能。
在这两个国家，与其他原因导致的气促相比，ADHF患者的血浆ERFE均较高（新西兰：4.9对1.4 ng/ml，<0.001）以及（新加坡：4.2对0.4 ng/ml，=0.021）。与新加坡队列相比，新西兰队列中用于鉴别ADHF的受试者工作特征（ROC）曲线下面积（AUC）对于ERFE（分别为0.75和0.84，=0.007）和NT-proBNP（分别为0.86和0.92，=0.004）均降低。ERFE的最佳截断点在两个队列中产生了相当的敏感性和阳性预测值，但与新西兰相比，新加坡的特异性、阴性预测值和准确性略好。在AF患者中，每个队列中ERFE的AUC均降低（新西兰：0.71，=105，新加坡：0.61，=44），但在肥胖患者中升高（新西兰：0.79，= 150，新加坡：0.87，=164）。
ADHF患者的循环ERFE高于其他新发气促原因的患者，具有一定的诊断效用，在亚洲患者中比在西方患者中表现更好。ERFE的诊断效能在AF患者中受损，但在肥胖患者中未受损。
