Prevalence, clinical phenotype, and outcomes associated with normal B-type natriuretic peptide levels in heart failure with preserved ejection fraction.
Prevalence, clinical phenotype, and outcomes associated with normal B-type natriuretic peptide levels in heart failure with preserved ejection fraction.
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DOI：
10.1016/j.amjcard.2012.05.014
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发表时间：
2012-09-15
期刊：
影响因子：
--
通讯作者：
Shah SJ
中科院分区：
文献类型：
--
作者：
Anjan VY;Loftus TM;Burke MA;Akhter N;Fonarow GC;Gheorghiade M;Shah SJ
B型利钠肽(BNP)被广泛用于排除呼吸困难患者的心力衰竭(HF)。然而，大多数关于BNP的研究都集中在诊断射血分数(EF)降低的心衰上。我们假设正常的BNP(≤100pg/ml)在EF保留的HF(HFpEF)中相对常见，这是一种通常与肥胖相关的异质性疾病。我们前瞻性地研究了159名参加西北大学HFpEF计划的连续患者。所有受试者均有症状性心衰，EF和GT；50%，肺毛细血管楔压升高。所有受试者均在基线时检测BNP。我们比较了正常(≤100pg/ml)和升高(>；100pg/ml)的HFpEF患者的临床特征、超声心动图参数、有创血流动力学和预后。在159HFpEF患者中，46例(29%)BNP≤为100pg/ml，BNP正常者年龄较小，多为女性，肥胖率较高，体重指数较高，较少有慢性肾脏疾病和心房颤动。BNP正常组和BNP增高组的EF和PCWP相似(62±7比61±7%[P=0.67]和25±8比27±9毫米汞柱[P=0.42])。脑钠素升高与左房容量增大、舒张期功能差、右室结构/功能异常及预后不良相关(例如，心力衰竭住院调整风险比=4.0，95%可信区间1.6-9.7，P=0.003)。总之，29%的有症状的HFpEF患者PCWP升高，BNP正常，肥胖可能是这一发现的主要驱动因素，尽管BNP作为HFpEF的预后标志物有用，但BNP正常并不排除门诊诊断HFpEF。
B-type natriuretic peptide (BNP) is used widely to exclude heart failure (HF) in patients with dyspnea. However, most studies of BNP have focused on diagnosing HF with reduced ejection fraction (EF). We hypothesized that a normal BNP (≤ 100 pg/ml) is relatively common in HF with preserved EF (HFpEF), a heterogeneous disorder commonly associated with obesity. We prospectively studied 159 consecutive patients enrolled in the Northwestern University HFpEF Program. All subjects had symptomatic HF with EF>50% and elevated pulmonary capillary wedge pressure (PCWP). BNP was tested at baseline in all subjects. We compared clinical characteristics, echocardiographic parameters, invasive hemodynamics, and outcomes among HFpEF patients with normal (≤ 100 pg/ml) vs. elevated (>100 pg/ml) BNP. Of the 159 HFpEF patients, 46 (29%) had BNP ≤ 100 pg/ml. Subjects with normal BNP were younger, more often female, had higher rates of obesity and higher body-mass index, and less commonly had chronic kidney disease and atrial fibrillation. Both EF and PCWP were similar in normal vs. elevated BNP groups (62±7 vs. 61±7% [P=0.67] and 25±8 vs. 27±9 mmHg [P=0.42], respectively). Elevated BNP was associated with enlarged left atrial volume, worse diastolic function, abnormal right ventricular structure/function, and worse outcomes (e.g., adjusted hazard ratio for HF hospitalization = 4.0, 95% confidence interval 1.6-9.7, P=0.003). In conclusion, a normal BNP is present in 29% of symptomatic outpatients with HFpEF who have elevated PCWP, obesity is likely the primary driver of this finding, and although BNP is useful as a prognostic marker in HFpEF, a normal BNP does not exclude the outpatient diagnosis of HFpEF.
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