Zemke Anna M, Zelnick Leila R, Ix Joachim H, Go Alan S, Siew Edward D, Bansal Nisha
Kidney Research Institute, Division of Nephrology University of Washington Seattle WA USA.
Division of Nephrology-Hypertension, Department of Medicine University of California San Diego San Diego CA USA.
J Am Heart Assoc. 2025 Jul 15;14(14):e039868. doi: 10.1161/JAHA.124.039868. Epub 2025 Jul 3.
In 2022 the American Heart Association/American College of Cardiology/Heart Failure Society of America Guidelines for Management of Heart Failure proposed an updated staging system with cardiac biomarkers to diagnose heart failure (HF) and its severity. The applicability of this staging system in chronic kidney disease is not well established.
This is a prospective cohort study of 2415 participants from CRIC (Chronic Renal Insufficiency Cohort). Individuals were classified into HF stages using 2013 and 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America HF guidelines using research echocardiograms, cardiac biomarkers (troponin T ≥10 ng/L [women], ≥15 ng/L [men], pro-B-type natriuretic peptide ≥125 pg/mL), laboratory measures, and history. Adjudicated outcomes of HF hospitalizations and all-cause mortality are reported.
In individuals with chronic kidney disease, participants with lower estimated glomerular filtration rates were more likely to be reclassified to a more advanced HF stage using the current proposed thresholds of hsTNT (high-sensitivity troponin T) and NT-proBNP (N-terminal pro-B-type natriuretic peptide). The 2022 guidelines reclassified 55% of 2013 guideline stage A participants to stage B. HF hospitalization incidence rates differed when individuals were categorized into stage B HF based on elevated hsTNT or NT-proBNP (1.7 per 100 person-years) compared with echocardiographic abnormalities (2.9 per 100 person-years), whereas death rates were similar between these groups.
Among individuals with CKD, the addition of elevated hsTNT or NT-proBNP to HF staging reclassified nearly 20% of total participants into a higher HF stage. These individuals had similar mortality rates to those previously in higher stages, but they had lower HF hospitalization rates. Those with more advanced chronic kidney disease were more likely to be reclassified.
2022年，美国心脏协会/美国心脏病学会/美国心力衰竭学会发布的心力衰竭管理指南提出了一种更新的分期系统，该系统结合心脏生物标志物来诊断心力衰竭（HF）及其严重程度。该分期系统在慢性肾脏病中的适用性尚未明确。
这是一项对慢性肾功能不全队列（CRIC）中2415名参与者进行的前瞻性队列研究。使用2013年和2022年美国心脏协会/美国心脏病学会/美国心力衰竭学会的心力衰竭指南，通过研究性超声心动图、心脏生物标志物（肌钙蛋白T≥10 ng/L[女性]，≥15 ng/L[男性]，B型利钠肽原≥125 pg/mL）、实验室检查结果和病史，将个体分为心力衰竭各阶段。报告了心力衰竭住院和全因死亡率的判定结果。
在慢性肾脏病患者中，使用当前提议的高敏肌钙蛋白T（hsTNT）和N末端B型利钠肽原（NT-proBNP）阈值时，估算肾小球滤过率较低的参与者更有可能被重新分类到更高级别的心力衰竭阶段。2022年指南将2013年指南中A期参与者的55%重新分类为B期。当根据hsTNT或NT-proBNP升高将个体分类为B期心力衰竭时，心力衰竭住院发病率（每100人年1.7例）与根据超声心动图异常分类时（每100人年2.9例）有所不同，而这些组之间的死亡率相似。
在慢性肾脏病患者中，将hsTNT或NT-proBNP升高纳入心力衰竭分期，使近20%的参与者被重新分类到更高的心力衰竭阶段。这些个体的死亡率与之前处于更高阶段的个体相似，但心力衰竭住院率较低。慢性肾脏病更严重的个体更有可能被重新分类。
