Diagnostic and Prognostic Utilities of Insulin-Like Growth Factor Binding Protein-7 in Patients With Dyspnea
Diagnostic and Prognostic Utilities of Insulin-Like Growth Factor Binding Protein-7 in Patients With Dyspnea
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DOI：
10.1016/j.jchf.2020.02.009
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发表时间：
2020-05-01
影响因子：
13
通讯作者：
Januzzi, James L., Jr.
中科院分区：
文献类型：
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作者：
Ibrahim, Nasrien E.;Afilalo, Marc;Januzzi, James L., Jr.
目的这项研究检查了胰岛素样生长因子结合蛋白7（IGFBP7）是否有助于急性心力衰竭（HF）超过N末端pro-B型NATRIETET肽（NT-Probnp）浓度。 IGFBP7与心室放松受损和预后较差有关。急诊科中急性诊断临界值的NT-ProBNP RE-RE-RE-RE-RE-RE-RE-RE-RE-RE-RE-RE-MEROCH临床试验是一项预期的，多中心的临床试验，招募了出现呼吸困难的受试者。在1,449例患者中获得了六个月的死亡或重复住院预后，274例（18.9％）被诊断为急性HF。在最高四分位数中具有IGFBP7浓度的人年龄较大，男性，患有高血压和HF，估计肾小球过滤率（EGFR）较低，射血分数最低（41 +/- 20％；全p <0.001）。 IGFBP7的独立预测因素是年龄，伴侣性别，糖尿病史，HF史和EGFR。急性HF患者（两者; P <0.001）的NT-螺旋中值（1844 ng/mt vs. 99 ng/ml）和IGFBP7（146.1 ng/mt vs. 86.1 ng/ml）的中位数较高。将IGFBP7添加到NT-ProBNP浓度中提高了歧视，因此增加了接收器工作曲线下的面积以诊断急性HF（从0.91到0.94；差异为p <0.001）。将IGFBP7添加到急性HF的独立预测指标的完整模型中，改善了模型校准。 IGFBP7显着重新分类了NT-Probnp以外的急性HF诊断（净添加指数：+0.25）。急性HF患者的较高日志（2）-IGFBP7浓度预测在6个月时死亡或重新住院（危险比：1.84 log（2）-SD； 95％置信区间：1.30至2.61； p = 0.001）。在Kaplan-Meier分析中，iGFBP7的浓度与较短的无事件生存期有关（对数秩：P <0.001）。急性呼吸困难的患者的结论，IGFBP7浓度，IGFBP7浓度添加到NT-ProBOBNP中，以诊断出HF和提供急性HF诊断急性HF和提供为短期风险增加了预后效用。 （c）2020年美国心脏病学院基金会。
OBJECTIVES This study examined whether insulin-like growth factor binding protein-7 (IGFBP7) would aid in the diagnosis and prognosis of acute heart failure (HF) beyond N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration.BACKGROUND IGFBP7 is associated with impaired ventricular relaxation and worse prognosis.METHODS The ICON-RELOADED (International Collaborative of NT-proBNP-Re-evaluation of Acute Diagnostic Cut-Offs in the Emergency Department) study was a prospective, multicenter clinical trial that enrolled subjects presenting with dyspnea. Six-month prognosis for death or repeat hospitalization was obtained.RESULTS Among 1,449 patients, 274 (18.9%) were diagnosed with acute HF. Those with IGFBP7 concentrations in the highest quartile were older, male, had hypertension and HF, had lower estimated glomerular filtration rate (eGFR) and lowest ejection fraction (41 +/- 20%; all p < 0.001). Independent predictors of IGFBP7 were age, mate sex, history of diabetes, history of HF, and eGFR. Median concentrations of NT-proBNP (1844 ng/mt vs. 99 ng/ml) and IGFBP7 (146.1 ng/mt vs. 86.1 ng/ml) were higher in those with acute HF (both; p < 0.001). Addition of IGFBP7 to NT-proBNP concentrations improved discrimination, therefore increasing the area under the receiver operating curve for diagnosis of acute HF (from 0.91 to 0.94; p < 0.001 for differences). Addition of IGFBP7 to a complete model of independent predictors of acute HF improved model calibration. IGFBP7 significantly reclassified acute HF diagnosis beyond NT-proBNP (net redassification index: +0.25). Higher log(2)-IGFBP7 concentrations in patients with acute HF predicted death or rehospitalization at 6 months (hazard ratio: 1.84 per log(2)-SD; 95% confidence interval: 1.30 to 2.61; p = 0.001). In Kaplan-Meier analyses, supramedian concentrations of IGFBP7 were associated with shorter event-free survival (log-rank: p < 0.001).CONCLUSIONS Among patients with acute dyspnea, concentrations of IGFBP7 add to NT-proBNP for diagnosis of acute HF and provide added prognostic utility for short-term risk. (C) 2020 by the American College of Cardiology Foundation.