Association of Copeptin and N-Terminal proBNP Concentrations With Risk of Cardiovascular Death in Older Patients With Symptoms of Heart Failure
Association of Copeptin and N-Terminal proBNP Concentrations With Risk of Cardiovascular Death in Older Patients With Symptoms of Heart Failure
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DOI：
10.1001/jama.2011.666
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发表时间：
2011-05-25
影响因子：
120.7
通讯作者：
Goetze, Jens P.
中科院分区：
文献类型：
--
作者：
Alehagen, Urban;Dahlstroem, Ulf;Goetze, Jens P.
尽管和肽素测量在老年患者中的价值尚不完全清楚，但测量生物标志物和肽素的血浆浓度可能有助于识别高死亡风险和低风险的心力衰竭患者。目的评估和肽素（加压素的替代标志物）血浆浓度与 B 型利尿钠肽前体 (NT-proBNP) 的 N 末端片段浓度相结合，与一组有心力衰竭症状的老年患者的死亡率之间的关联。环境和参与者 瑞典的初级卫生保健人群在 1996 年 1 月至 12 月期间招募了 470 名出现心力衰竭症状的老年患者。进行了临床检查、超声心动图和肽浓度测量，并随访至 2009 年 12 月。主要结果测量全因死亡率和心血管死亡率。结果 中位随访 13 年后，有 226 例因各种原因死亡，其中 146 例因心血管原因死亡。和肽素浓度增加与全因死亡率（第四四分位数与第一四分位数：分别为 69.5% vs 38.5%；风险比 [HR]，2.04 [95% 置信区间 {CI}，1.38-3.02]）和心血管死亡率（第四四分位数与第一四分位数：46.6% vs 26.5%；HR，1.94）风险增加相关。 [95% CI，1.20-3.13]）。 NT-proBNP 浓度升高和和肽素浓度升高的组合也与全因死亡风险增加相关（和肽素第四个四分位数：HR，1.63 [95% CI，1.08-2.47]；P=0.01；NT-proBNP 第四个四分位数：HR，3.17 [95% CI，2.02-4.98]；P
Context Measurement of plasma concentrations of the biomarker copeptin may help identify patients with heart failure at high and low risk of mortality, although the value of copeptin measurement in elderly patients is not fully known.Objective To evaluate the association between plasma concentrations of copeptin, a surrogate marker of vasopressin, combined with concentrations of the N-terminal fragment of the precursor to B-type natriuretic peptide (NT-proBNP), and mortality in a cohort of elderly patients with symptoms of heart failure.Design, Setting, and Participants Primary health care population in Sweden enrolling 470 elderly patients with heart failure symptoms between January and December 1996. Clinical examination, echocardiography, and measurement of peptide concentrations were performed, with follow-up through December 2009.Main Outcome Measures All-cause mortality and cardiovascular mortality.Results After a median follow-up of 13 years, there were 226 deaths from all causes, including 146 deaths from cardiovascular causes. Increased concentration of copeptin was associated with increased risk of all-cause mortality (fourth quartile vs first quartile: 69.5% vs 38.5%, respectively; hazard ratio [HR], 2.04 [95% confidence interval {CI}, 1.38-3.02]) and cardiovascular mortality (fourth quartile vs first quartile: 46.6% vs 26.5%; HR, 1.94 [95% CI, 1.20-3.13]). The combination of elevated NT-proBNP concentrations and elevated copeptin concentrations also was associated with increased risk of all-cause mortality (copeptin fourth quartile: HR, 1.63 [95% CI, 1.08-2.47]; P=.01; NT-proBNP fourth quartile: HR, 3.17 [95% CI, 2.02-4.98]; P