动态左心室射血分数下降以及心脏移植前血清N末端B型利钠肽原和尿酸水平是年轻扩张型心肌病患者不良预后的独立预测因素。
Dynamic LVEF Decline and Serum NT-proBNP and Uric Acid Levels before Heart Transplantation are Independent Predictors of Adverse Outcomes in Young Adult Patients with Dilated Cardiomyopathy.
作者信息
Li Jian, Mi Shouling, Wang Meng, Li Mengwan, Guo Qilong, Yang Fan, Ge Junhua
机构信息
Department of Cardiology, Qingdao Municipal Key Laboratory of Hypertension (Key Laboratory of Cardiovascular Medicine), The Affiliated Hospital of Qingdao University, 266000 Qingdao, Shandong, China.
Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, 200032 Shanghai, China.
出版信息
Rev Cardiovasc Med. 2024 Apr 30;25(5):153. doi: 10.31083/j.rcm2505153. eCollection 2024 May.
BACKGROUND
The present study investigated the predictors of adverse outcomes in young adult patients with dilated cardiomyopathy (DCM) who underwent heart transplantation (HTx).
METHODS
Twenty-four young adult patients (aged 18-45 years) with DCM who underwent HTx in our hospital from January 2012 to December 2022 were included in this retrospective analysis. Pre- and post-HTx data were collected for echocardiography, N-terminal pro-brain natriuretic peptide (NT-proBNP), and uric acid (UA). Data collected at the time of DCM diagnosis were designated as baseline data. Post-HTx assessments were conducted at 1 week and 3, 6, 12, and 36 months post-HTx. The primary endpoint was defined as any adverse event, including left ventricular ejection fraction (LVEF) 50% (n = 3), 50% increase in right or left ventricular diameter (n = 12), or death (n = 2). Patients were categorized into a non-adverse-event group (n = 12) or an adverse-event group (n = 12).
RESULTS
Baseline NT-proBNP ( = 0.014) and UA ( = 0.012) were significantly higher in the adverse-event group than in the non-adverse-event group. Baseline NT-proBNP 7390 pg/mL (relative risk (RR) = 7.412, = 0.046), UA 542 µmol/L (RR = 8.838, 95% confidence interval (95% CI) = 1.541-50.694, = 0.014), and sustained reduction in LVEF ( 3%) over a 2-year pharmacological treatment prior to HTx (RR = 3.252, = 0.046) were significantly associated with an increased risk of adverse events post-HTx.
CONCLUSIONS
In young adult DCM patients post-HTx, heightened baseline levels of NT-proBNP and UA levels and a sustained reduction in LVEF over time prior to undergoing an HTx are significantly associated with an increased risk of adverse events post-HTx. Future studies are needed to observe whether individualized monitoring strategies could reduce the incidence of adverse events following HTx in these patients.
背景
本研究调查了接受心脏移植（HTx）的年轻扩张型心肌病（DCM）成年患者不良结局的预测因素。
方法
本回顾性分析纳入了2012年1月至2022年12月在我院接受HTx的24例年轻成年DCM患者（年龄18 - 45岁）。收集HTx前后的超声心动图、N末端脑钠肽前体（NT-proBNP）和尿酸（UA）数据。将DCM诊断时收集的数据指定为基线数据。在HTx后1周以及3、6、12和36个月进行HTx后评估。主要终点定义为任何不良事件，包括左心室射血分数（LVEF）<50%（n = 3）、右心室或左心室直径增加50%（n = 12）或死亡（n = 2）。患者被分为非不良事件组（n = 12）或不良事件组（n = 12）。
结果
不良事件组的基线NT-proBNP（P = 0.014）和UA（P = 0.012）显著高于非不良事件组。基线NT-proBNP>7390 pg/mL（相对风险（RR）= 7.412，P = 0.046）、UA>542 µmol/L（RR = 8.838，95%置信区间（95%CI）= 1.541 - 50.694，P = 0.014）以及HTx前2年药物治疗期间LVEF持续降低（>3%）（RR = 3.252，P = 0.046）与HTx后不良事件风险增加显著相关。
结论
在接受HTx的年轻成年DCM患者中，HTx前NT-proBNP和UA的基线水平升高以及LVEF随时间持续降低与HTx后不良事件风险增加显著相关。未来需要研究观察个体化监测策略是否可以降低这些患者HTx后不良事件的发生率。
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