Sakamoto Daisuke, Sotomi Yohei, Matsuoka Yuki, Nakatani Daisaku, Okada Katsuki, Sunaga Akihiro, Kida Hirota, Sato Taiki, Kitamura Tetsuhisa, Seo Masahiro, Yano Masamichi, Hayashi Takaharu, Nakagawa Akito, Nakagawa Yusuke, Tamaki Shunsuke, Yasumura Yoshio, Yamada Takahisa, Hikoso Shungo, Sakata Yasushi
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
J Card Fail. 2025 May;31(5):771-780. doi: 10.1016/j.cardfail.2024.10.440. Epub 2024 Nov 16.
N-terminal pro brain natriuretic peptide (NT-proBNP) is a biomarker for myocardial stress that is used in diagnosing and prognosticating heart failure (HF). However, its interpretation is complicated by clinical factors. This study aims to clarify the prognostic value of NT-proBNP in patients with heart failure with preserved ejection fraction (HFpEF), and risk-prediction cutoffs considering various clinical factors.
The study used data from the prospective, multicenter, observational Asian HFpEF registry. Patients with acute decompensated HF and left ventricular ejection fraction ≥ 50% were included. NT-proBNP levels were measured at discharge. The primary endpoint was a composite of all-cause death and hospitalization due to HF within 1 year after discharge.
A total of 1231 patients (83 [77-87] years old, 551 [45%] male) were enrolled, and 916 eligible patients were analyzed. The median NT-proBNP level was 1060 pg/m. In a multivariable logistic regression model, NT-proBNP was significantly associated with the primary endpoint (adjusted OR for log-transformed NT-proBNP: 2.71, 95% CI: 1.78-4.18; P < 0.001). Subgroup analysis revealed varying NT-proBNP distributions and differential safety cutoffs (329-929 pg/mL) at sensitivity of 0.8 based on factors such as atrial fibrillation and chronic kidney disease, maintaining its discriminatory performance (area under the curve: 0.587-0.734).
NT-proBNP levels at discharge are a significant prognostic marker for HFpEF. Although NT-proBNP levels showed different distributions in various subgroups, and cutoff values were distinctive for each, the prognostic utility was found to be equivalent in almost all subgroups and had similar moderate discriminative performance. The study highlights the necessity of personalized NT-proBNP cutoffs for better management of and prognostication for patients with HFpEF.
N 末端脑钠肽前体（NT-proBNP）是一种心肌应激生物标志物，用于心力衰竭（HF）的诊断和预后评估。然而，其解读受临床因素影响较为复杂。本研究旨在阐明 NT-proBNP 在射血分数保留的心力衰竭（HFpEF）患者中的预后价值，以及考虑各种临床因素的风险预测临界值。
本研究使用了来自前瞻性、多中心、观察性亚洲 HFpEF 注册研究的数据。纳入急性失代偿性 HF 且左心室射血分数≥50%的患者。出院时测量 NT-proBNP 水平。主要终点是出院后 1 年内全因死亡和因 HF 住院的复合终点。
共纳入 1231 例患者（年龄 83[77 - 87]岁，551 例[45%]为男性），对 916 例符合条件的患者进行了分析。NT-proBNP 水平中位数为 1060 pg/m。在多变量逻辑回归模型中，NT-proBNP 与主要终点显著相关（NT-proBNP 对数转换后的调整 OR：2.71，95%CI：1.78 - 4.18；P < 0.001）。亚组分析显示，基于房颤和慢性肾病等因素，在灵敏度为 0.8 时，NT-proBNP 分布不同，安全临界值也不同（329 - 929 pg/mL），其鉴别性能得以维持（曲线下面积：0.587 - 0.734）。
出院时的 NT-proBNP 水平是 HFpEF 的重要预后标志物。尽管 NT-proBNP 水平在不同亚组中显示出不同分布，且每个亚组的临界值不同，但发现其在几乎所有亚组中的预后效用相当，且具有相似的中等鉴别性能。该研究强调了个性化 NT-proBNP 临界值对于更好地管理和预测 HFpEF 患者的必要性。
