Prognostic value of changes in N-terminal pro-brain natriuretic peptide in Val-HeFT (Valsartan Heart Failure Trial)
Prognostic value of changes in N-terminal pro-brain natriuretic peptide in Val-HeFT (Valsartan Heart Failure Trial)
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DOI：
10.1016/j.jacc.2008.04.069
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发表时间：
2008-09-16
影响因子：
24
通讯作者：
Cohn, Jay N.
中科院分区：
文献类型：
--
作者：
Masson, Serge;Latini, Roberto;Cohn, Jay N.
目的本研究旨在评估N末端脑钠肽前体随时间的变化与脑梗死的关系。在稳定和慢性心力衰竭（HF）患者中，NT-proBNP以不同的方式和结果表达。背景虽然先前的研究检查了重复测定BNP在HF中的预后价值，在有足够随访时间的大量非卧床慢性HF患者中，关于连续测量无活性肽NT-proBNP的临床效用的数据有限。在Val-HeFT（缬沙坦心力衰竭试验）安慰剂组招募的1，742例患者中，在随机化时和4个月后测量proBNP。NT-proBNP浓度在4个月内的变化表示为相对于基线的绝对变化、相对变化百分比或跨越阈值的分类变化，并与随后的死亡率相关。（4个月时的曲线下面积：0.702，95%置信区间[CI]：0.669至0.735）显示出比浓度连续变化更高的预后鉴别力，（0.592，95% CI：0.549至0.634）或相对变化（0.602，95% CI：0.566至0.639）。考克斯比例风险模型显示，根据间隔4个月的2个时间点的NT-proBNP水平将患者分为4类，相对于阈值浓度，提供了慢性HF患者的预后信息，超出了单次测定的结果。proBNP浓度和根据阈值水平将变化分类为几个类别可能是慢性和稳定性HF患者风险分层的上级策略。
Objectives This study sought to evaluate the association between changes over time of N-terminal pro-brain natriuretic peptide (NT-proBNP) expressed in different ways and outcome in patients with stable and chronic heart failure (HF).Background Although previous studies examined the prognostic value of repeated determinations of BNP in HF, there are only limited data on the clinical utility of serial measurements of the inactive peptide NT-proBNP in a large population of ambulatory patients with chronic HF with sufficient follow-up time.Methods The NT-proBNP was measured at randomization and after 4 months in 1,742 patients enrolled in the placebo arm of Val-HeFT (Valsartan Heart Failure Trial). Changes in NT-proBNP concentrations over 4 months were expressed as absolute change from baseline, percent relative changes, or categorical changes across a threshold value and related to subsequent mortality.Results A single determination of NT-proBNP (area under the curve at 4 months: 0.702, 95% confidence interval [CI]: 0.669 to 0.735) showed a higher prognostic discrimination than continuous changes of concentrations, expressed either as absolute (0.592, 95% CI: 0.549 to 0.634) or relative changes (0.602, 95% CI: 0.566 to 0.639). A Cox proportional hazards model showed that stratification of patients into 4 categories according to NT-proBNP levels at 2 time points 4 months apart with respect to a threshold concentration provided prognostic information in patients with chronic HF beyond that of a single determination.Conclusions Serial determinations of NT-proBNP concentration and classification into few categories of changes according to threshold levels may be a superior strategy for risk stratification of patients with chronic and stable HF.