Berezina Tetiana A, Berezin Oleksandr O, Novikov Evgen V, Lichtenauer Michael, Berezin Alexander E
Department of Internal Medicine and Nephrology, VitaCenter, 69000 Zaporozhye, Ukraine.
Luzerner Psychiatrie AG, 4915 St. Urban, Switzerland.
Biomolecules. 2024 Dec 17;14(12):1615. doi: 10.3390/biom14121615.
Despite existing evidence of the high predictive value of natriuretic peptides (NPs) in patients with heart failure (HF), patients treated with guideline-directed therapy who have low or near-normal NP levels are unlikely to be correctly stratified for risk of clinical outcomes. The aim of this study is to detect plausible predictors for poor one-year clinical outcomes in patients with HFpEF and low NT-proBNP treated with in accordance with conventional guidelines.
A total of 337 patients with HF with preserved ejection fraction (HFpEF) who had low levels of N-terminal natriuretic pro-peptide (NT-proBNP) at discharge due to optimal guideline-based therapy were enrolled in the study. The course of the observation was 3 years. Echocardiography and the assessment of conventional hematological and biochemical parameters, including NT-proBNP, tumor necrosis factor-alpha, high-sensitivity C-reactive protein (hs-CRP), adropin, irisin, visfatin, and fetuin-A, were performed at baseline and at the end of the study.
Three-year cumulative clinical endpoints (cardiovascular death, myocardial infarction or unstable angina or acute coronary syndrome, worsening HF, sudden cardiac death, or cardiac-related surgery or all-cause death) were detected in 104 patients, whereas 233 did not meet the endpoint. After adjusting for an age ≥ 64 years and a presence of atrial fibrillation, diabetes mellitus, chronic kidney disease (CKD) stages 1-3 and dilated cardiomyopathy, the multivariable Cox regression analysis showed that an irisin level of ≤7.2 ng/mL was an independent predictor of cumulative clinical endpoint. Moreover, patients with levels of irisin > 7.2 ng/mL had a better Kaplan-Meier survival rate than those with a lower serum irisin level (≤7.2 ng/mL).
Multivariable analysis showed that an age ≥ 64 years; the presence of atrial fibrillation, diabetes mellitus, CKD stages 1-3 and dilated cardiomyopathy; an LAVI ≥ 39 mL/m; and serum levels of hs-CRP ≥ 6.10 mg/L, irisin ≤ 7.2 ng/mL, and visfatin ≤ 1.1 ng/mL were predictors of poor clinical outcomes in HFpEF with low levels of NT-proBNP. A serum level of irisin ≤ 7.2 ng/mL could emerge as valuable biomarker for predicting long-term prognosis among HFpEF patients with low or near-normal levels of NT-proBNP.
尽管有证据表明利钠肽（NP）对心力衰竭（HF）患者具有较高的预测价值，但接受指南指导治疗且NP水平低或接近正常的患者不太可能被正确分层以评估临床结局风险。本研究的目的是检测按照传统指南治疗的射血分数保留的心力衰竭（HFpEF）且N末端B型利钠肽原（NT-proBNP）水平低的患者1年内不良临床结局的合理预测因素。
本研究共纳入337例射血分数保留的心力衰竭（HFpEF）患者，这些患者因基于指南的最佳治疗在出院时N末端利钠肽前体（NT-proBNP）水平较低。观察期为3年。在基线和研究结束时进行超声心动图检查，并评估包括NT-proBNP、肿瘤坏死因子-α、高敏C反应蛋白（hs-CRP）、内脂素、鸢尾素、内脏脂肪素和胎球蛋白-A在内的传统血液学和生化参数。
104例患者出现了3年累积临床终点（心血管死亡、心肌梗死或不稳定型心绞痛或急性冠状动脉综合征、心力衰竭恶化、心源性猝死或心脏相关手术或全因死亡），而233例未达到终点。在调整年龄≥64岁、存在心房颤动、糖尿病、慢性肾脏病（CKD）1-3期和扩张型心肌病后，多变量Cox回归分析显示鸢尾素水平≤7.2 ng/mL是累积临床终点的独立预测因素。此外，鸢尾素水平>7.2 ng/mL的患者的Kaplan-Meier生存率高于血清鸢尾素水平较低（≤7.2 ng/mL）的患者。
多变量分析显示，年龄≥64岁；存在心房颤动、糖尿病、CKD 1-3期和扩张型心肌病；左房容积指数（LAVI）≥39 mL/m²；以及血清hs-CRP水平≥6.10 mg/L、鸢尾素≤7.2 ng/mL和内脏脂肪素≤1.1 ng/mL是NT-proBNP水平低的HFpEF患者不良临床结局的预测因素。血清鸢尾素水平≤7.2 ng/mL可能成为预测NT-proBNP水平低或接近正常的HFpEF患者长期预后的有价值生物标志物。
