N-TERMINAL PROATRIAL NATRIURETIC FACTOR - AN INDEPENDENT PREDICTOR OF LONG-TERM PROGNOSIS AFTER MYOCARDIAL-INFARCTION
N-TERMINAL PROATRIAL NATRIURETIC FACTOR - AN INDEPENDENT PREDICTOR OF LONG-TERM PROGNOSIS AFTER MYOCARDIAL-INFARCTION
复制标题
DOI：
10.1161/01.cir.89.5.1934
复制
发表时间：
1994-05-01
期刊：
影响因子：
37.8
通讯作者：
PFEFFER, MA
中科院分区：
文献类型：
--
作者：
HALL, C;ROULEAU, JL;PFEFFER, MA
研究背景心房利钠因子(ANF)是一种由心脏心房分泌的多肽类激素，可对心房压力升高作出反应。由于ANF前激素的N-末端(N-末端proANF)具有较长的半衰期和较高的稳定性，因此可能比ANF本身更能整合心房肽的分泌。心肌梗死后，ANF和其他神经激素升高与预后不良有关。然而，当将左心室射血分数(LVEF)等重要临床变量纳入多因素分析时，这些神经激素的独立预测价值已显著降低。方法与结果在存活和心室扩大(SAVE)研究中，检测246例心肌梗死后12天的血浆N-末端心钠素原浓度，以检验其预后价值。N端proANF是一个比ANF本身更强的生存预测因子。此外，在心血管死亡率和心力衰竭发展的多因素分析中，当模型包括年龄、性别、既往心肌梗死、高血压、糖尿病、溶栓使用、Killip分级、梗死部位和LVEF时，与ANF和其他神经激素相比，N-末端proANF仍然是一个强大和独立的预测因子。结论N-末端proANF的测定补充了目前使用的临床和客观评估，并为心血管死亡和心力衰竭的发展提供了重要的独立预后预测因子。
Background Atrial natriuretic factor (ANF) is a peptide hormone secreted from cardiac atria in response to increased atrial pressure. Because of a longer half-life and greater stability, the N-terminal of ANF prohormone (N-terminal proANF) may be a better integrator of atrial peptide secretion than ANF itself. After myocardial infarction, elevation of ANF and other neurohormones has been associated with a poor prognosis. However, when left ventricular ejection fraction (LVEF) and other important clinical variables are included in multivariate analysis, the independent predictive value of these neurohormones has been reduced markedly.Methods and Results To test the prognostic value of N-terminal proANF after myocardial infarction, its plasma concentration was measured a mean of 12 days after infarction in 246 patients in the Survival and Ventricular Enlargement (SAVE) Study. N-terminal proANF was a much stronger predictor of survival than ANF itself. Furthermore, in multivariate analysis of cardiovascular mortality and development of heart failure, N-terminal proANF in contrast to ANF and other neurohormones was still a powerful and independent predictor when the model included age, gender, prior myocardial infarction, hypertension, diabetes, use of thrombolysis, Killip class, infarct location, and LVEF.Conclusions The measurement of N-terminal proANF supplements presently used clinical and objective assessments and provides an important independent predictor of prognosis with respect to cardiovascular mortality and development of heart failure.