pro-B-type natriuretic peptide levels in acute decompensated heart failure
pro-B-type natriuretic peptide levels in acute decompensated heart failure
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DOI：
10.1016/j.jacc.2007.12.051
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发表时间：
2008-05-13
影响因子：
24
通讯作者：
Maisel, Alan S.
中科院分区：
文献类型：
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作者：
Waldo, Stephen W.;Beede, Jennifer;Maisel, Alan S.
目的探讨血浆B型利钠肽前体（pro-B-type natriuretic peptides，proBNP）在急性失代偿性心力衰竭（acute decompensated heart failure，ACHF）患者中的临床应用价值。然而，这些多肽（proBNP（1-108））的前体在血浆中循环，可能会干扰目前使用的生物标志物的测量。方法血浆利钠肽进行了评估，在164个人（99%的男性）因失代偿性心力衰竭住院。将入院和出院时的B型利钠肽（BNP）、NT-proBNP和proBNP水平与出院后90天内的心源性死亡和全因死亡率进行比较。（R = 0.924，p < 0.001）和NT-proBNP（R = 0.802，p < 0.001）。proBNP的进一步表征表明，随着年龄、体重指数、肌酐或收缩功能障碍的变化，proBNP几乎没有变化。心源性死亡或全因死亡的患者入院时血浆三种利钠肽均显著升高（p < 0.05）。受试者工作特征曲线表明，入院和出院时NT-proBNP（曲线下面积[AUC] 0.788和AUC 0.834）与BNP相比，对全因死亡率具有上级预后能力结论所有利钠肽的入院值均可预测心源性死亡和全因死亡。初步比较表明，NT-proBNP的出院值具有预测这些终点的最大诊断率。进一步的研究应该探索所有利钠肽的协同预后潜力。
Objectives The present study sought to evaluate the clinical utility of pro-B-type natriuretic peptides (proBNP) in patients admitted with acute decompensated heart failure.Background Plasma natriuretic peptides (BNP1-32, N-terminal [NT]-proBNP(1-76)) have been demonstrated to assist in the diagnosis of patients with heart failure. However, the precursor to these polypeptides (proBNP(1-108)) circulates in plasma and may interfere with the measurement of currently used biomarkers.Methods Plasma natriuretic peptides were assessed in 164 individuals (99% men) hospitalized with decompensated heart failure. The B-type natriuretic peptide (BNP), NT-proBNP, and proBNP levels at hospital admission and discharge were compared with the incidence of cardiac death and all-cause mortality within 90 days post-discharge.Results Pro-B-type natriuretic peptides demonstrated a high degree of correlation with both BNP (R = 0.924, p < 0.001) and NT-proBNP (R = 0.802, p < 0.001) at admission. Further characterization of proBNP demonstrated little variation with changes in age, body mass index, creatinine, or systolic dysfunction. All 3 plasma natriuretic peptides were significantly elevated at admission in patients suffering a cardiac death or all-cause mortality (p < 0.05). Receiver-operating characteristic curves demonstrated that admission and discharge NT-proBNP (area under the curve [AUC] 0.788 and AUC 0.834) had superior prognostic power for all-cause mortality when compared with BNP (AUC 0.644, p < 0.01 and AUC 0.709, p < 0.01) and proBNP (AUC 0.653, p < 0.01 and AUC 0.666, p < 0.01) at the same time points.Conclusions Admission values of all natriuretic peptides can be used to predict cardiac death and all-cause mortality. A preliminary comparison suggests that discharge values of NT-proBNP have the greatest diagnostic yield for predicting these end points. Further studies should explore the synergistic prognostic potential of all natriuretic peptides.