Effect of Serum Albumin Levels in Patients With Heart Failure With Preserved Ejection Fraction (from the TOPCAT Trial)
Effect of Serum Albumin Levels in Patients With Heart Failure With Preserved Ejection Fraction (from the TOPCAT Trial)
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DOI：
10.1016/j.amjcard.2019.11.006
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发表时间：
2020-02-15
影响因子：
2.8
通讯作者：
Chirinos, Julio A.
中科院分区：
文献类型：
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作者：
Prenner, Stuart B.;Kumar, Anupam;Chirinos, Julio A.
关于射血分数(HFpEF)保留的心力衰竭患者血清白蛋白的决定因素和预后意义的资料很少。我们试图检验白蛋白的表型相关性及其在HFpEF中的独立预后意义。我们分析了参加TOPCAT试验的3,254名受试者的数据。我们根据白蛋白的等级对受试者进行分层，并检查了这些层级之间各种表型特征的差异，包括从受试者子集(n=372)中获得的冷冻样本中特别选择并测量的8种蛋白质生物标记物。我们还评估了白蛋白和试验主要终点之间的关系。低白蛋白与高龄、黑人、NYHA III-IV级外周动脉疾病、心房颤动和糖尿病的高患病率相关。较低的白蛋白还与几种炎症生物标志物、肝纤维化标志物、蛋白尿的水平升高以及更大的动脉僵硬、舒张期功能障碍和肺动脉高压相关。白蛋白是主要试验终点的有力预测因子，即使在对MAGGIC风险评分进行调整后(危险比[HR]0.72，可信区间[CI]0.67至0.78；p
Little data are available regarding the determinants and prognostic significance of serum albumin in Heart Failure with Preserved Ejection Fraction (HFpEF). We sought to examine the phenotypic correlates of albumin and its independent prognostic implications in HFpEF. We analyzed data from 3,254 subjects enrolled the TOPCAT trial. We stratified subjects according to tertiles of albumin and examined differences in various phenotypic traits between these strata, including 8 protein biomarkers selected ad hoc and measured from frozen samples available in a subset of participants (n = 372). We also assessed the relationship between albumin and the trial primary endpoint. Lower albumin was associ- ated with older age, black race, and greater prevalence of NYHA class III-IV peripheral arterial disease, atrial fibrillation and diabetes mellitus. Lower albumin was also associated with increased levels of several inflammatory biomarkers, markers of liver fibrosis, albuminuria, and greater arterial stiffness, diastolic dysfunction and pulmonary hypertension. Albumin was a strong predictor of the primary trial endpoint, even after adjustment for the MAGGIC risk score (hazard ratio [HR] 0.72, confidence interval [CI] 0.67 to 0.78; p