Horiuchi Yu, Matsue Yuya, Wettersten Nicholas, Oishi Shogo, Akiyama Eiichi, Suzuki Satoshi, Yamamoto Masayoshi, Kida Keisuke, Okumura Takahiro, Kitai Takeshi, van Veldhuisen Dirk J, Maisel Alan, Murray Patrick T, Minamino Tohru
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.; Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan..
J Cardiol. 2025 Jun;85(6):486-493. doi: 10.1016/j.jjcc.2025.01.013. Epub 2025 Jan 30.
Whether variability of B-type natriuretic peptide (BNP) values between races affects its clinical integration as a marker for congestion and predictor of prognosis in acute heart failure (AHF) remains unknown. We aimed to investigate the relationship between diuretic therapy, change in BNP value, and prognosis in AHF in relation to racial differences.
This analysis combined data from the AKINESIS and REALITY-AHF studies. We included White, Black, and Asian individuals admitted with AHF requiring intravenous diuretic therapy. We examined the relative change in BNP values at 48 h post hospital admission, and its association with diuretic therapy and one-year mortality.
Of 1380 participants, 29 % were White, 12 % were Black, and 58 % were Asian. Admission BNP values were highest in Black, followed by Asian and White individuals. After adjusting for confounding factors, Black individuals had significantly higher admission BNP values compared to White individuals. During the first 48 h of hospitalization, Asian individuals received the lowest diuretic dose but demonstrated the greatest diuretic response and BNP decrease. After adjustment for confounding factors, Asian individuals were more likely to have a BNP decrease compared to White individuals. Higher admission BNP values predicted higher one-year mortality in White and Asian but not in Black individuals (p for interaction = 0.021). BNP decrease was associated with a lower one-year mortality without a significant interaction by race.
In AHF patients, admission BNP was higher in Black, and its decrease after diuretic therapy was greater in Asian individuals. A BNP decrease predicted a better prognosis, regardless of race.
种族间B型利钠肽（BNP）值的变异性是否会影响其作为急性心力衰竭（AHF）中充血标志物和预后预测指标的临床应用，目前尚不清楚。我们旨在研究利尿剂治疗、BNP值变化与AHF预后之间的种族差异关系。
本分析合并了AKINESIS和REALITY-AHF研究的数据。我们纳入了因AHF入院且需要静脉利尿剂治疗的白人、黑人和亚洲个体。我们检查了入院后48小时BNP值的相对变化，及其与利尿剂治疗和一年死亡率的关联。
在1380名参与者中，29%为白人，12%为黑人，58%为亚洲人。入院时BNP值黑人最高，其次是亚洲人和白人。在调整混杂因素后，黑人入院时的BNP值显著高于白人。在住院的前48小时内，亚洲个体接受的利尿剂剂量最低，但利尿剂反应和BNP降低幅度最大。调整混杂因素后，与白人相比，亚洲个体的BNP更有可能降低。较高的入院BNP值预测白人及亚洲人的一年死亡率较高，但对黑人则不然（交互作用p值=0.021）。BNP降低与较低的一年死亡率相关，且种族间无显著交互作用。
在AHF患者中，黑人入院时的BNP较高，亚洲个体利尿剂治疗后BNP降低幅度更大。无论种族如何，BNP降低均预示着更好的预后。
