B-type natriuretic peptide and risk of sudden death in patients with hypertrophic cardiomyopathy
B-type natriuretic peptide and risk of sudden death in patients with hypertrophic cardiomyopathy
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DOI：
10.1016/j.hrthm.2018.04.030
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发表时间：
2018-10-01
期刊：
影响因子：
5.5
通讯作者：
Hagiwara, Nobuhisa
中科院分区：
文献类型：
--
作者：
Minami, Yuichiro;Haruki, Shintaro;Hagiwara, Nobuhisa
背景：肥厚型心肌病（HCM）患者B型利钠肽（BNP）水平与心源性猝死的关系尚不清楚。目的：本研究评价BNP水平升高对HCM患者猝死风险的影响。结果研究组患者血浆BNP水平中位数为197.2（84.4-353.3）pg/mL，平均值为197.2（84.4-353.3）pg/mL。在8.4（4.2-12.5）年的中位（四分位距）随访期内，37例患者（10.7%）发生了猝死或潜在致死性脑血管事件的联合终点，包括11例猝死患者（3.2%），8例心脏骤停后复苏，18例适当植入除颤器电击。BNP对联合终点的预后价值的时间依赖性受试者工作特征曲线分析显示，Harrell一致性指数为0.748，最佳BNP截断点为312 pg/mL。高BNP水平（>312 pg/mL）患者的猝死风险（Gray检验，P = 0.001）和联合终点（Gray检验，P <0.001）显著高于低BNP水平（
BACKGROUND The association between B-type natriuretic peptide (BNP) levels and sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM) remains unclear.OBJECTIVE This study evaluated the effect of elevated BNP levels on sudden death risk in a cohort of patients with HCM.METHODS This study included 346 patients with HCM. Plasma BNP levels were measured at the initial evaluation.RESULTS The median (interquartile range) BNP level in the study patients was 197.2 (84.4-353.3) pg/mL. During a median (interquartile range) follow-up period of 8.4 (4.2-12.5) years, 37 patients (10.7%) experienced the combined end point of sudden death or potentially lethal arrhythmic events, including 11 patients with sudden death (3.2%), 8 resuscitated after cardiac arrest, and 18 with appropriate implantable defibrillator shocks. Time-dependent receiver operating characteristic curve analysis of the prognostic value of BNP for the combined end point showed that the Harrell's concordance index was 0.748 and the optimal BNP cutoff point was 312 pg/mL. Patients with high BNP levels (>312 pg/mL) were at a significantly higher risk of sudden death (Gray test, P = .001) and the combined end point (Gray test, P < 001) than were patients with low BNP levels (