Simultaneous assessment of unprocessed ProBNP1-108 in addition to processed BNP32 improves identification of high-risk ambulatory patients with heart failure.
Simultaneous assessment of unprocessed ProBNP1-108 in addition to processed BNP32 improves identification of high-risk ambulatory patients with heart failure.
复制标题
除了加工后的BNP32外，同时评估未经处理的ProbNP1-108还可以改善对心力衰竭的高危卧床患者的识别。
DOI：
10.1161/circheartfailure.109.903153
复制
发表时间：
2010-03
期刊：
影响因子：
--
通讯作者：
Cappola TP
中科院分区：
文献类型：
--
作者：
Dries DL;Ky B;Wu AH;Rame JE;Putt ME;Cappola TP
B-type natriuretic peptide (BNP) is produced as a biologically inactive prohormone (proBNP1-108), processed, and released as an inactive amino-terminal fragment (NT-proBNP1-76) and a biologically active carboxyl-terminal fragment (proBNP77-108 or BNP32). We hypothesized that simultaneous assessment of proBNP1-108 and active BNP32, as an index of natriuretic peptide processing efficiency, would improve risk stratification in patients with chronic systolic heart failure. We quantified plasma proBNP1-108 and BNP32 in 756 subjects in the Penn Heart Failure Study, a prospective cohort of outpatients with predominantly systolic heart failure. Cox models were used to determine the association between biomarker level at time of study entry and incident risk of adverse cardiovascular outcomes. A significant amount of unprocessed proBNP1-108 circulates in patients with systolic heart failure (median 271 pg/ml, interquartile range 65 to 825). Higher levels of proBNP1-108 were associated with an increased risk of all-cause death or cardiac transplantation (adjusted HR 4.9, 95% CI 2.5–9.7, p<0.001 comparing 3rd versus 1st proBNP1-108 tertile). ProBNP1-108 provided additive information to BNP32 risk assessment, particularly in patients with BNP32 less than the median of 125 pg/ml (adjusted HR 1.4, 95% CI 1.2–1.8, p<0.001 per doubling of proBNP1-108). Circulating proBNP1-108 is independently associated with an increased risk of adverse cardiovascular outcomes in ambulatory patients with chronic systolic heart failure. The combined assessment of BNP32 and proBNP1-108 provides additional information in determining risk of adverse clinical outcomes, particularly in patients with low BNP32 values that might otherwise be reassuring to the clinician.
