Núñez-Marín Gonzalo, Palau Patricia, Domínguez Eloy, de la Espriella Rafael, López Laura, Flor Cristina, Marín Paloma, Lorenzo Miguel, Miñana Gema, Bodí Vicent, Sanchis Juan, Núñez Julio
Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain.
Faculty of Medicine, Universitat de València, Valencia, Spain.
Clin Kidney J. 2024 Jul 2;17(8):sfae199. doi: 10.1093/ckj/sfae199. eCollection 2024 Aug.
Heart failure with preserved ejection fraction (HFpEF) often coexists with chronic kidney disease (CKD). Exercise intolerance is a major determinant of quality of life and morbidity in both scenarios. We aimed to evaluate the associations between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and carbohydrate antigen 125 (CA125) with maximal aerobic capacity (peak VO) in ambulatory HFpEF and whether these associations were influenced by kidney function.
This single-centre study prospectively enrolled 133 patients with HFpEF who performed maximal cardiopulmonary exercise testing. Patients were stratified across estimated glomerular filtration rate (eGFR) categories (<60 ml/min/1.73 m versus ≥60 ml/min/1.73 m).
The mean age of the sample was 73.2 ± 10.5 years and 56.4% were female. The median of peak VO was 11.0 ml/kg/min (interquartile range 9.0-13.0). A total of 67 (50.4%) patients had an eGFR <60 ml/min/1.73 m. Those patients had higher levels of NT-proBNP and lower peak VO, without differences in CA125. In the whole sample, NT-proBNP and CA125 were inversely correlated with peak VO ( = -0.43, < .001 and = -0.22, = .010, respectively). After multivariate analysis, we found a differential association between NT-proBNP and peak VO across eGFR strata ( for interaction = .045). In patients with an eGFR ≥60 ml/min/1.73 m, higher NT-proBNP identified patients with poorer maximal functional capacity. In individuals with eGFR <60 ml/min/1.73 m, NT-proBNP was not significantly associated with peak VO [β = 0.02 (95% confidence interval -0.19-0.23), = .834]. Higher CA125 was linear and significantly associated with worse functional capacity without evidence of heterogeneity across eGFR strata ( for interaction = .620).
In patients with stable HFpEF, NT-proBNP was not associated with maximal functional capacity when CKD was present. CA125 emerged as a useful biomarker for estimating effort intolerance in HFpEF irrespective of the presence of CKD.
射血分数保留的心力衰竭（HFpEF）常与慢性肾脏病（CKD）并存。运动不耐受是这两种情况下生活质量和发病率的主要决定因素。我们旨在评估N末端B型利钠肽原（NT-proBNP）和糖类抗原125（CA125）与门诊HFpEF患者最大有氧能力（峰值VO₂）之间的关联，以及这些关联是否受肾功能影响。
这项单中心研究前瞻性纳入了133例接受最大心肺运动试验的HFpEF患者。根据估计的肾小球滤过率（eGFR）类别（<60 ml/min/1.73 m²与≥60 ml/min/1.73 m²）对患者进行分层。
样本的平均年龄为73.2±10.5岁，56.4%为女性。峰值VO₂的中位数为11.0 ml/kg/min（四分位间距9.0 - 13.0）。共有67例（50.4%）患者的eGFR<60 ml/min/1.73 m²。这些患者的NT-proBNP水平较高，峰值VO₂较低，CA125无差异。在整个样本中，NT-proBNP和CA125与峰值VO₂呈负相关（分别为r = -0.43，P <.001和r = -0.22，P = .010）。多因素分析后，我们发现NT-proBNP与峰值VO₂在不同eGFR分层之间存在差异关联（交互作用P = .045）。在eGFR≥60 ml/min/1.73 m²的患者中，较高的NT-proBNP表明最大功能能力较差的患者。在eGFR<60 ml/min/1.73 m²的个体中，NT-proBNP与峰值VO₂无显著关联[β = 0.02（95%置信区间 -0.19 - 0.23），P = .834]。较高的CA125与较差的功能能力呈线性且显著相关，在不同eGFR分层中无异质性证据（交互作用P = .620）。
在稳定的HFpEF患者中，存在CKD时NT-proBNP与最大功能能力无关。无论是否存在CKD，CA125都成为评估HFpEF运动不耐受的有用生物标志物。
