Okamoto Chisato, Tsukamoto Osamu, Hasegawa Takuya, Matsuoka Ken, Amaki Makoto, Kanzaki Hideaki, Izumi Chisato, Takashima Seiji, Ito Shin, Kitakaze Masafumi
Department of Cardiovascular Medicine, Hanwa Memorial Hospital Osaka Japan.
Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences Suita Japan.
Circ Rep. 2024 Apr 20;6(5):151-160. doi: 10.1253/circrep.CR-24-0026. eCollection 2024 May 10.
Heart failure patients are deficient in B-type natriuretic peptide (BNP) but the significance of subclinical BNP deficiency is unclear. A total of 1,398 subjects without cardiovascular disease, with left ventricular ejection fraction (LVEF) ≥50% and BNP level <100 pg/mL, were selected from a 2005-2008 health checkup in Arita-cho, Japan, and divided into 2 groups: with and without LV diastolic dysfunction (DD+ or DD-). We performed propensity score matching on non-cardiac factors affecting BNP levels and analyzed 470 subjects in each group (372/940 men; median age, 66 years). The DD(+) group showed higher lateral E/e', an index of estimated left ventricular filling pressure, and greater prevalence of concentric hypertrophy (CH) despite similar BNP levels, suggesting a relative deficiency of BNP in DD(+) compared with DD(-). Multivariable logistic regression analysis revealed an increase in BNP correlated with decreased odds of CH (adjusted odds ratio [aOR] 0.663, 95% confidence interval (CI) 0.484-0.909, P=0.011), whereas an increase in lateral E/e' was associated with increased odds of CH (aOR, 2.881; 95% CI, 1.390-5.973; P=0.004). Furthermore, CH in combination with diastolic dysfunction independently predicted major adverse cardiovascular events (hazard ratio 3.272, 95% CI 1.215-8.809; P=0.019). Relative BNP deficiency was associated with CH, which had a poor prognosis in patients with diastolic dysfunction.
心力衰竭患者存在B型利钠肽（BNP）缺乏，但亚临床BNP缺乏的意义尚不清楚。从日本有田町2005 - 2008年的健康检查中选取了1398名无心血管疾病、左心室射血分数（LVEF）≥50%且BNP水平<100 pg/mL的受试者，并将其分为两组：有或无左心室舒张功能障碍（DD+或DD-）。我们对影响BNP水平的非心脏因素进行倾向得分匹配，并分析每组中的470名受试者（372/940名男性；中位年龄66岁）。尽管BNP水平相似，但DD(+)组显示出更高的侧壁E/e'（估计左心室充盈压的指标）和更高的向心性肥厚（CH）患病率，这表明与DD(-)组相比，DD(+)组中BNP相对缺乏。多变量逻辑回归分析显示，BNP升高与CH几率降低相关（调整后的优势比[aOR]为0.663，95%置信区间[CI]为0.484 - 0.909，P = 0.011），而侧壁E/e'升高与CH几率增加相关（aOR为2.881；95% CI为1.390 - 5.973；P = 0.004）。此外，CH与舒张功能障碍共同独立预测主要不良心血管事件（风险比为3.272，95% CI为1.215 - 8.809；P = 0.019）。相对BNP缺乏与CH相关，CH在舒张功能障碍患者中预后较差。
