Ohte Nobuyuki, Kikuchi Shohei, Iwahashi Noriaki, Kinugasa Yoshiharu, Dohi Kaoru, Takase Hiroyuki, Inoue Katsuji, Okumura Takahiro, Hachiya Kenta, Sugiura Emiyo, Kusunose Kenya, Kitada Shuichi, Seo Yoshihiro
Department of Cardiology, Nagoya City University Graduate School of Medical Sciences Nagoya Japan.
Department of Cardiology, Yokohama City University School of Medicine Yokohama Japan.
Circ Rep. 2025 Feb 8;7(3):191-197. doi: 10.1253/circrep.CR-24-0172. eCollection 2025 Mar 10.
In heart failure (HF) patients with a higher left ventricular ejection fraction (LVEF), the B-type natriuretic peptide (BNP) level is yet to be fully assessed. Accordingly, we hypothesized that the BNP level should be higher in patients with a higher LVEF range based on the previous finding that such patients were associated with a worse prognosis.
In our multicenter, prospective, observational cohort for the composite endpoint of all-cause death and readmission due to HF, including patients with LVEF >40% at hospital discharge, we obtained LVEF, E/e', and BNP levels in 231 patients. The concurrent atrial fibrillation (AF) was confirmed by electrocardiogram. Patients were divided into HF with mildly reduced EF (HFmrEF), HF with preserved EF (HFpEF) with LVEF ≥50 and <60%, and HFpEF with LVEF ≥60%. The BNP levels were not significantly different among these groups (median [interquartile range]: 195 [110-348] vs. 242 [150-447] vs. 220 [125-320] pg/mL, respectively; P=0.422). In contrast, a BNP level of ≥377 pg/mL could significantly differentiate event-free survival (P<0.001). In the multi-covariate Cox proportional hazards model, the BNP level was significantly related to event-free survival independent of LVEF, E/e', and concurrent AF.
Without confounding the effects of LVEF, E/e', and concurrent AF, higher BNP levels are significantly and independently associated with event-free survival in HF patients with LVEF>40%.
在左心室射血分数（LVEF）较高的心力衰竭（HF）患者中，B型利钠肽（BNP）水平尚未得到充分评估。因此，基于之前发现此类患者预后较差这一结果，我们推测LVEF范围较高的患者BNP水平应该更高。
在我们针对全因死亡和因HF再次入院这一复合终点的多中心、前瞻性、观察性队列研究中，纳入了出院时LVEF>40%的患者，我们获取了231例患者的LVEF、E/e'和BNP水平。通过心电图确认并发心房颤动（AF）情况。患者被分为射血分数轻度降低的HF（HFmrEF）、LVEF≥50%且<60%的射血分数保留的HF（HFpEF）以及LVEF≥60%的HFpEF。这些组之间的BNP水平无显著差异（中位数[四分位间距]：分别为195[110 - 348]、242[150 - 447]和220[125 - 320]pg/mL；P = 0.422）。相比之下，BNP水平≥377 pg/mL能够显著区分无事件生存期（P<0.001）。在多变量Cox比例风险模型中，BNP水平与无事件生存期显著相关，且独立于LVEF、E/e'和并发AF。
在不混淆LVEF、E/e'和并发AF影响的情况下，较高的BNP水平与LVEF>40%的HF患者的无事件生存期显著且独立相关。
