Prognostic Value and Kinetics of Soluble Neprilysin in Acute Heart Failure A Pilot Study
Prognostic Value and Kinetics of Soluble Neprilysin in Acute Heart Failure A Pilot Study
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DOI：
10.1016/j.jchf.2015.03.006
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发表时间：
2015-08-01
影响因子：
13
通讯作者：
Lupon, Josep
中科院分区：
文献类型：
--
作者：
Bayes-Genis, Antoni;Barallat, Jaume;Lupon, Josep
目的 本研究旨在探讨可溶性脑啡肽酶 (sNEP) 在急性心力衰竭 (AHF) 中的预后价值以及入院期间的 sNEP 动力学。 背景 sNEP 最近在慢性心力衰竭 (HF) 中被发现，并且与心血管结局相关。 方法 共有 350 名患者（53% 为女性，平均年龄 72.6 +/- 10.7 岁）纳入研究研究。主要终点是短期（2 个月）和长期（平均：1.8 +/- 1.2 年）随访时心血管死亡或心衰住院的复合终点。使用特别改良的酶联免疫吸附测定法测量 sNEP，并使用 Cox 回归分析评估其预后价值。在一个患者亚组中，在入院和出院时均测量了 sNEP (n = 92)。 结果 入院 sNEP 浓度中位数为 0.67 ng/ml（Q1 至 Q3：0.37 至 1.29），在年龄调整的 Cox 回归分析中，sNEP 与短期复合终点显着相关（风险比 [HR]：1.29；95% 置信区间） [CI]：1.04至1.61；p = 0.02）和长期（HR：1.23；95% CI：1.01至1.05；p = 0.003）随访。在包括临床变量和 N 端脑钠肽原 (NT-proBNP) 浓度的多变量 Cox 分析中，入院时的 sNEP 浓度显示出明显的趋势，对 2 个月时的复合终点具有显着性（HR：1.22；95% CI：0.97 至 1.53；p = 0.09），并且在随访结束时仍然显着（HR：1.21；95% CI： 1.04 至 1.40；p = 0.01）。出院时，sNEP 水平从 0.70 ng/ml 下降至 0.52 ng/ml (p = 0.06)。 结论 入院 sNEP 浓度与 AHF 的短期和长期结局相关，入院期间观察到动态 sNEP 浓度。这些初步数据可能是 NEP 抑制剂在 AHF 中使用的假设。 (C) 2015 年，美国心脏病学会基金会。
OBJECTIVES This study sought to examine the prognostic value of the soluble form of neprilysin (sNEP) in acute heart failure (AHF) and sNEP kinetics during hospital admission.BACKGROUND sNEP was recently identified in chronic heart failure (HF) and was associated with cardiovascular outcomes.METHODS A total of 350 patients (53% women, mean 72.6 +/- 10.7 years of age) were included in the study. Primary endpoints were composites of cardiovascular death or HF hospitalizations at short-term (2 months) and long-term (mean: 1.8 +/- 1.2 years) follow-up. sNEP was measured using an ad hoc-modified enzyme-linked immunosorbent assay, and its prognostic value was assessed using Cox regression analyses. In a subgroup of patients, sNEP was measured both at admission and at discharge (n = 92).RESULTS Median admission sNEP concentrations were 0.67 ng/ml (Q1 to Q3: 0.37 to 1.29), and sNEP was significantly associated, in age-adjusted Cox regression analyses, with the composite endpoint at short-term (hazard ratio [HR]: 1.29; 95% confidence interval [CI]: 1.04 to 1.61; p = 0.02) and long-term (HR: 1.23; 95% CI: 1.01 to 1.05; p = 0.003) follow-up. In multivariate Cox analyses that included clinical variables and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration, sNEP concentration at admission showed a clear trend toward significance for the composite endpoint at 2 months (HR: 1.22; 95% CI: 0.97 to 1.53; p = 0.09) and remained significant at the end of followup (HR: 1.21; 95% CI: 1.04 to 1.40; p = 0.01). At discharge, sNEP levels decreased from 0.70 to 0.52 ng/ml (p = 0.06).CONCLUSIONS Admission sNEP concentration was associated with short-and long-term outcomes in AHF, and dynamic sNEP concentrations were observed during hospital admission. These preliminary data may be hypothesisgenerating for the use of NEP inhibitors in AHF. (C) 2015 by the American College of Cardiology Foundation.