Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin - Prognostic utility and prediction of benefit from carvedilol in chronic ischemic left ventricular dysfunction
Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin - Prognostic utility and prediction of benefit from carvedilol in chronic ischemic left ventricular dysfunction
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DOI：
10.1016/s0735-1097(01)01269-4
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发表时间：
2001-06-01
影响因子：
24
通讯作者：
Yandle, TG
中科院分区：
文献类型：
--
作者：
Richards, AM;Doughty, R;Yandle, TG
在297例缺血性左心室功能障碍患者中，我们试图评估血浆脑钠肽前体（N-BNP）氨基末端部分和肾上腺髓质素的浓度，以预测不良结局和对治疗的反应，这些患者被随机分配接受卡维地洛或安慰剂。N-BNP或肾上腺髓质素在慢性缺血性LV功能障碍中的预测能力以前没有报道过。方法在297例慢性缺血性（LV）功能障碍患者中随机分为卡维地洛组或安慰剂组，在已建立的治疗基础上加用转换酶抑制剂和袢利尿剂（加或不加地高辛），测定血浆N-BNP和肾上腺髓质素。记录患者18个月的临床结局，包括死亡率和心力衰竭事件。结果N-BNP和肾上腺髓质素水平中位数增加风险死亡率（所有p < 0.001）（风险比[95%置信区间]：4.67 [2-10.9]和3.92 [1.76-8.7]）和因心力衰竭住院（分别为4.7 [2.2-10.3]和2.4 [1.3-4.5]）。这两项指标均预测死亡或心力衰竭，与年龄、纽约心脏协会心功能分级、左室射血分数、既往心肌梗死或既往因心力衰竭入院无关。卡维地洛降低了死亡或心力衰竭的风险，高于中位数水平的N-BNP或肾上腺髓质素，或两者兼而有之，利率没有显着不同的水平低于中位数value.CONCLUSIONS在患者中观察到的缺血性左心室功能障碍，血浆N-BNP和肾上腺髓质素是独立的预测死亡率和心力衰竭。卡维地洛降低了治疗前血浆N-BNP和肾上腺髓质素水平较高的患者的死亡率和心力衰竭。（美国科尔心脏病学杂志2001;37：1781-7）（C）2001年美国心脏病学会。
OBJECTIVES We sought to assess plasma concentrations of the amino (N)-terminal portion of pro-brain natriuretic peptide (N-BNP) and adrenomedullin for prediction of adverse outcomes and responses to treatment in 297 patients with ischemic left ventricular (LV) dysfunction who were randomly assigned to receive carvedilol or placebo.BACKGROUND Although neurohormonal status has known prognostic significance in heart failure, the predictive power of either N-BNP or adrenomedullin in chronic ischemic LV dysfunction has not been previously reported.METHODS Plasma N-BNP and adrenomedullin were measured in 297 patients with chronic ischemic (LV) dysfunction before randomization to carvedilol or placebo, added to established treatment with a converting enzyme inhibitor and loop diuretic (with or without digoxin). The patients' clinical outcomes, including mortality and heart failure events, were recorded for 18 months.RESULTS Above-median N-BNP and adrenomedullin levels conferred increased risks (all p < 0.001) of mortality (risk ratios [95% confidence intervals]: 4.67 [2-10.9] and 3.92 [1.76-8.7], respectively) and hospital admission with heart failure (4.7 [2.2-10.3] and 2.4 [1.3-4.5], respectively). Both of these predicted death or heart failure independent of age, New York Heart Association functional class, LV ejection fraction, previous myocardial infarction or previous admission with heart failure. Carvedilol reduced the risk of death or heart failure in patients with above-median levels of N-BNP or adrenomedullin, or both, to rates not significantly different from those observed in patients with levels below the median value.CONCLUSIONS In patients with established ischemic LV dysfunction, plasma N-BNP and adrenomedullin are independent predictors of mortality and heart failure. Carvedilol reduced mortality and heart failure in patients with higher pre-treatment plasma N-BNP and adrenomedullin. (J Am Coll Cardiol 2001;37:1781-7) (C) 2001 by the American College of Cardiology.