Seither Benedikt, Schober Alexander, Allgaier Raphael, Meindl Christine, Paulus Michael, Hubauer Ute, Schober Andreas, Ücer Ekrem, Fredersdorf Sabine, Lehn Petra, Keyser Andreas, Luchner Andreas, Maier Lars, Wallner Stefan, Jungbauer Carsten
University Hospital Regensburg, Germany.
University Hospital Regensburg, Germany.
Indian Pacing Electrophysiol J. 2024 Nov-Dec;24(6):315-320. doi: 10.1016/j.ipej.2024.10.006. Epub 2024 Oct 24.
Plasma NT-proBNP is an established marker of heart failure. Previous studies suggested urinary NT-proBNP has potential as marker of chronic heart failure as well. The objective of this study was to compare urinary NT-proBNP to plasma NT-proBNP in a real-life collective of patients with an ICD, especially regarding ICD-therapies.
METHODS & RESULTS: NT-proBNP was assessed in plasma and fresh spot urine (the latter related to urinary creatinine) from 322 patients of our ICD outpatient clinic. 54 healthy individuals served as a control group. Follow-up regarding mortality and ICD therapies was performed after 32 months (IQR 5-35 months). Plasma and urinary NT-proBNP was positively correlated (r = 0.89, p < 0,001). According to ROC analysis urinary NT-proBNP detected LV dysfunction (EF<35 % vs. healthy CTRL) with very satisfying predictive values (AUC 0.95), but plasma NT-proBNP showed slightly better values (AUC 0.99). Patients who received appropriate ICD-shock-therapies showed significantly higher plasma (p < 0.001) as well as urinary NT-proBNP levels (p = 0.011) compared to patients without shock-therapy. In Kaplan-Meier analysis, plasma as well as urinary NT-proBNP levels > Youden-Index showed significantly higher event rates for appropriate ICD-shock therapies (p < 0.001 and p = 0.016) and the combined endpoint of all-cause-mortality and shock therapies (each p < 0.001). Urinary and plasma NT-proBNP were independent predictors for appropriate ICD-shock-therapies and for the combined endpoint of all-cause mortality and appropriate ICD-shock-therapies (each p < 0.001).
Urinary NT-proBNP as a marker for LV dysfunction and symptomatic heart failure showed promising predictive values. Associations between plasma as well as urinary NT-proBNP and ICD shock-therapies could be shown.
血浆N末端B型利钠肽原（NT-proBNP）是心力衰竭的既定标志物。先前的研究表明，尿NT-proBNP也有作为慢性心力衰竭标志物的潜力。本研究的目的是在植入式心律转复除颤器（ICD）患者的实际群体中比较尿NT-proBNP和血浆NT-proBNP，特别是在ICD治疗方面。
对我院ICD门诊的322例患者的血浆和新鲜晨尿（后者与尿肌酐相关）中的NT-proBNP进行了评估。54名健康个体作为对照组。32个月（四分位间距5 - 35个月）后对死亡率和ICD治疗进行随访。血浆和尿NT-proBNP呈正相关（r = 0.89，p < 0.001）。根据ROC分析，尿NT-proBNP检测左心室功能障碍（射血分数<35% 与健康对照组相比）具有非常令人满意的预测价值（曲线下面积0.95），但血浆NT-proBNP显示出稍好的值（曲线下面积0.99）。与未接受电击治疗的患者相比，接受适当ICD电击治疗的患者血浆（p < 0.001）以及尿NT-proBNP水平显著更高（p = 0.011）。在Kaplan-Meier分析中，血浆以及尿NT-proBNP水平>约登指数显示适当ICD电击治疗的事件发生率显著更高（p < 0.001和p = 0.016）以及全因死亡率和电击治疗的联合终点（各p < 0.001）。尿和血浆NT-proBNP是适当ICD电击治疗以及全因死亡率和适当ICD电击治疗联合终点的独立预测因素（各p < 0.001）。
尿NT-proBNP作为左心室功能障碍和有症状心力衰竭的标志物显示出有前景的预测价值。可以显示血浆以及尿NT-proBNP与ICD电击治疗之间的关联。
