Change in Cardiac Biomarkers and Risk of Incident Heart Failure and Atrial Fibrillation in CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study.
Change in Cardiac Biomarkers and Risk of Incident Heart Failure and Atrial Fibrillation in CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study.
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DOI：
10.1053/j.ajkd.2020.09.021
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
CRIC Study Investigators
中科院分区：
文献类型：
--
作者：
Bansal N;Zelnick LR;Soliman EZ;Anderson A;Christenson R;DeFilippi C;Deo R;Feldman HI;He J;Ky B;Kusek J;Lash J;Seliger S;Shafi T;Wolf M;Go AS;Shlipak MG;CRIC Study Investigators
循环心脏生物标志物可能是心力衰竭(HF)和心房颤动(AF)的潜在机制信号。循环心脏生物标志物的单一测量与慢性肾脏疾病(CKD)中发生的心衰和房颤密切相关。我们检测了CKD患者N端B型利钠肽原(NT-proBNP)、高敏肌钙蛋白T(HsTnT)、Galectin-3、生长分化因子-15(GDF-15)和可溶性ST-2(SST-2)的纵向变化与心力衰竭和房颤的关系。观察性病例队列研究设计。患有慢性肾脏病的成年人参加了CRIC研究。未患ESRD的患者在基线和两年后进行生物标记物测定。我们在每个生物标志物中创建了三类绝对变化：最低四分位数，中间两个四分位数和最高四分位数。主要结果是发生心力衰竭和房颤。COX比例风险回归模型用于检验每个心脏生物标记物的变化类别与每个结果的相关性(中间两个变化的四分之一作为参照组)，调整潜在的混杂因素和每个生物标记物的基线浓度。心力衰竭事件分析包括789例(包括138例心力衰竭事件)，房颤事件分析包括774名参与者(包括123例心力衰竭事件)。在多变量模型中，与参照组相比，NT-proBNP变化的上四分位数(超过2年的232pg/ml)与发生心力衰竭(HR 1.79，95%CI：1.06，3.04)和房颤(HR 2.32，95%CI：1.37，3.93)的风险增加相关。与两个中四分位数相比，Sst2变化的前四分位数(2年以上3.37 ng/ml)的参与者发生心力衰竭的风险显著增加(HR 1.89，95%CI：1.13，3.16)，而那些位于后四分位数(≤−3.78 ng/ml，两年以上)的参与者发生房颤的风险(HR 2.43，95%CI：1.39，4.22)显著增加。HsTnT、Galectin-3或GDF-15的变化与心力衰竭或房颤的发生没有关联。在慢性肾脏病的观察性研究中，NT-proBNP的增加与发生心衰和房颤的风险显著相关；而Sst2的增加与心衰相关。进一步的研究应该调查这些亚临床心血管疾病的标记物是否可以被修改以降低慢性肾脏病心血管疾病的风险。慢性肾脏疾病患者发生心力衰竭和心房颤动的风险更高，原因尚不完全清楚。在血液中测量的心脏生物标志物可能有助于洞察导致心力衰竭和心房颤动风险较高的可能机制。在这项研究中，我们研究了心脏生物标志物随时间的变化及其与心力衰竭和心房颤动发展的关系。我们发现，这些心脏生物标志物中的两个(NT-proBNP和Sst2)在两年内的增加与心力衰竭的风险显著相关；而Sst2的增加与心房颤动的风险更高相关。
Circulating cardiac biomarkers may signal potential mechanistic pathways involved in heart failure (HF) and atrial fibrillation (AF). Single measures of circulating cardiac biomarkers are strongly associated with incident HF and AF in chronic kidney disease (CKD). We tested the associations of longitudinal changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP), high sensitivity troponin T (hsTnT), galectin-3, growth differentiation factor-15 (GDF-15), and soluble ST-2 (sST-2) with incident HF and AF in patients with CKD. Observational, case-cohort study design. Adults with CKD enrolled in the CRIC study. Biomarkers were measured at baseline and 2 years later among those without ESRD. We created three categories of absolute change in each biomarker: the lowest quartile, the middle two quartiles and the top quartile. The primary outcomes were incident HF and AF. Cox proportional hazards regression models were used to test the associations of the change categories of each cardiac biomarker with each outcome (the middle two quartiles of change as the referent group), adjusting for potential confounders and baseline concentrations of each biomarker. The incident HF analysis included 789 (which included 138 incident HF cases) and the incident AF analysis included 774 participants (which included 123 incident AF cases). In multivariable models, top quartile of NT-proBNP change (>232 pg/mL over 2 years) was associated with increased risk of incident HF (HR 1.79, 95% CI: 1.06, 3.04) and AF (HR 2.32, 95% CI: 1.37, 3.93) compared with the referent group. Participants in the top quartile of sST2 change (>3.37 ng/ml over 2 years) had significantly greater risk of incident HF (HR 1.89, 95% CI: 1.13, 3.16), whereas those in the bottom quartile (≤ −3.78 ng/ml over 2 years) had greater risk of incident AF (HR 2.43, 95% CI: 1.39, 4.22) compared with the two middle quartiles. There was no association of changes in hsTnT, galectin-3 or GDF-15 with incident HF or AF. observational study In CKD, increases in NT-proBNP were significantly associated with greater risk of incident HF and AF; and increases in sST2 were associated with HF. Further studies should investigate whether these markers of subclinical cardiovascular disease can be modified to reduce the risk of cardiovascular disease in CKD. Patients with chronic kidney disease are at higher risk of developing heart failure and atrial fibrillation for reasons that are not completely understood. Cardiac biomarkers measured in the blood may provide insight into possible mechanisms that contribute to the higher risk of heart failure and atrial fibrillation. In this study we examined changes in cardiac biomarkers over time and their association with development of heart failure and atrial fibrillation. We found that increases over two years in two of these cardiac biomarkers (NT-proBNP and sST2) were significantly associated with higher risk of heart failure; and increases in sST2 were associated with higher risk of atrial fibrillation.
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影响因子：
24
作者：
Bansal N;Katz R;Robinson-Cohen C;Odden MC;Dalrymple L;Shlipak MG;Sarnak MJ;Siscovick DS;Zelnick L;Psaty BM;Kestenbaum B;Correa A;Afkarian M;Young B;de Boer IH
通讯作者：
de Boer IH
影响因子：
5.4
作者：
Bansal, Nisha;Zelnick, Leila;Townsend, Raymond R.
通讯作者：
Townsend, Raymond R.
影响因子：
6
作者：
Boisot, Saskia;Beede, Jennifer;Fitzgerald, Robert L.
通讯作者：
Fitzgerald, Robert L.
DOI：
10.1161/atvbaha.110.213512
发表时间：
2011-01-01
影响因子：
8.7
作者：
Bonaca, Marc P.;Morrow, David A.;Wollert, Kai C.
通讯作者：
Wollert, Kai C.
影响因子：
3.2
作者：
Czaya, Brian;Seeherunvong, Wacharee;Freundlich, Michael
通讯作者：
Freundlich, Michael