Relationship of ejection fraction and natriuretic peptide trajectories in heart failure with baseline reduced and mid-range ejection fraction.
Relationship of ejection fraction and natriuretic peptide trajectories in heart failure with baseline reduced and mid-range ejection fraction.
复制标题
DOI：
10.1016/j.ahj.2021.08.015
复制
发表时间：
2022-01
影响因子：
4.8
通讯作者：
Mazimba S
中科院分区：
文献类型：
--
作者：
Bilchick KC;Stafford P;Laja O;Elumogo C;Bediako P;Tolbert N;Sawch D;David S;Sodhi N;Barber A;Kwon Y;Mehta N;Patterson B;Breathett K;Mazimba S
在EF降低和中程心力衰竭（HFrEF和HFmrEF）患者中，神经激素与左心室功能随时间变化的轨迹对预后的重要性尚不明确。评价HFrEF和HFmrEF患者左室射血分数（LVEF）和b型利钠肽（BNP）的变化轨迹。采用三种方法对伴有左室收缩功能异常的心力衰竭患者入院后LVEF和BNP轨迹进行分析：含时变协变量的Cox比例风险模型，具有共享随机效应的双纵向生存模型，以及捕获每个参数的三个离散轨迹的无监督分析。在1158例患者（68.9±13.0岁，53.3%女性）中，随时间变化的LVEF测量值（p=0.001）和对数转换的BNP测量值（p=2×10−16）与协变量调整后6年内的生存率独立相关。在双纵向/生存模型中，LVEF和BNP轨迹再次与生存独立相关（每个模型的p<0.0001）；然而，LVEF比BNP更具动态性（LVEF纵向模型的时间协变量p <0.0001，而BNP纵向模型的时间协变量p=0.88）。在无监督分析中，确定了三个离散的LVEF轨迹（将队列划分为大约三分之一）和三个离散的BNP轨迹。离散的LVEF和BNP轨迹在Kaplan Meier分析中具有独立的预后价值（p<0.0001），并且注意到BNP和LVEF轨迹之间的大量成员变异。尽管LVEF轨迹具有更大的时间变化，但BNP轨迹提供了附加预后，并且与左室收缩功能异常的心力衰竭患者的生存时间有更强的关联。心衰预后的双轨迹分析。首先进行时变协变量生存模型和共享随机效应双纵向-生存模型的轨迹分析，然后进行离散轨迹的无监督分析。显示了三个离散的LVEF轨迹，三个BNP轨迹及其与预后的关系。
The prognostic importance of trajectories of neurohormones relative to left ventricular function over time in heart failure with reduced and mid-range EF (HFrEF and HFmrEF) is poorly defined. To evaluate left ventricular ejection fraction (LVEF) and B-type natriuretic peptide (BNP) trajectories in HFrEF and HFmrEF. Analyses of LVEF and BNP trajectories after incident HF admissions presenting with abnormal LV systolic function were performed using three methods: a Cox proportional hazards model with time-varying covariates, a dual longitudinal-survival model with shared random effects, and an unsupervised analysis to capture three discrete trajectories for each parameter. Among 1,158 patients (68.9 ± 13.0 years, 53.3% female), both time-varying LVEF measurements (p=0.001) and log-transformed BNP measurements (p=2×10−16) were independently associated with survival during six years after covariate adjustment. In the dual longitudinal/survival model, both LVEF and BNP trajectories again were independently associated with survival (p<0.0001 in each model); however, LVEF was more dynamic than BNP (p <0.0001 for time covariate in LVEF longitudinal model versus p=0.88 for the time covariate in BNP longitudinal model). In the unsupervised analysis, three discrete LVEF trajectories (dividing the cohort into approximately thirds) and three discrete BNP trajectories were identified. Discrete LVEF and BNP trajectories had independent prognostic value in Kaplan Meier analyses (p<0.0001), and substantial membership variability across BNP and LVEF trajectories was noted. Although LVEF trajectories have greater temporal variation, BNP trajectories provide additive prognostication and an even stronger association with survival times in heart failure patients with abnormal LV systolic function. Dual Trajectory Analysis for Prognosis in Heart Failure. Trajectory analyses based on the survival model with time-varying covariates and the dual longitudinal-survival model with shared random effects were performed, then an unsupervised analysis based on discrete trajectories was performed. The three discrete LVEF trajectories, the three BNP trajectories, and their associations with prognosis are shown.
登录
查看更多内容
DOI：
10.1016/j.jchf.2017.09.009
发表时间：
2017-11
期刊：
JACC. Heart failure
影响因子：
--
作者：
Bristow MR;Kao DP;Breathett KK;Altman NL;Gorcsan J 3rd;Gill EA;Lowes BD;Gilbert EM;Quaife RA;Mann DL
通讯作者：
Mann DL
影响因子：
37.8
作者：
Yancy, Clyde W.;Jessup, Mariell;Westlake, Cheryl
通讯作者：
Westlake, Cheryl
影响因子：
--
作者：
Ebong, Imo;Mazimba, Sula;Breathett, Khadijah
通讯作者：
Breathett, Khadijah
DOI：
10.1161/circheartfailure.111.966366
发表时间：
2012-11
期刊：
Circulation. Heart failure
影响因子：
--
作者：
Dunlay SM;Roger VL;Weston SA;Jiang R;Redfield MM
通讯作者：
Redfield MM
影响因子：
45.3
作者：
Ibrahim, Joseph G.;Chu, Haitao;Chen, Liddy M.
通讯作者：
Chen, Liddy M.