Coronary Sinus Neuropeptide Y Levels and Adverse Outcomes in Patients With Stable Chronic Heart Failure
Coronary Sinus Neuropeptide Y Levels and Adverse Outcomes in Patients With Stable Chronic Heart Failure
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DOI：
10.1001/jamacardio.2019.4717
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发表时间：
2020-03-01
期刊：
影响因子：
24
通讯作者：
Herring, Neil
中科院分区：
文献类型：
--
作者：
Ajijola, Olujimi A.;Chatterjee, Neal A.;Herring, Neil
问题关键点肾上腺素能共递质神经肽Y(NPY)是否与稳定性心力衰竭(HF)患者的预后相关？在一组接受心脏再同步化治疗装置植入的稳定型心力衰竭患者中，采集冠状静脉窦血检测NPY水平。确定了NPY的阈值水平，它与死亡、心脏移植和放置心脏辅助装置有关；对人类交感神经元的分子研究表明，心力衰竭患者NPY的释放增加。提示慢性心力衰竭(CHF)与交感神经驱动力增强有关，可能增加交感神经细胞内共递质神经肽Y(NPY)的表达。目的探讨稳定性充血性心力衰竭(CHF)患者心肌NPY水平与预后的关系。设计、设置和参与者在一家单中心三级护理医院进行前瞻性观察队列研究。2013至2015年间，接受选择性心脏再同步治疗装置植入的心力衰竭患者病情稳定。主要结果和措施慢性心力衰竭住院、死亡、原位心脏移植和放置心脏辅助装置。结果105例患者(平均年龄68[12]岁；男性82例[78%]；平均[SD]左心室射血分数[LVEF]26%[7%])在心脏再同步化治疗(CRT)装置植入过程中采集冠状静脉窦(CS)血。前瞻性地收集了临床、实验室和结果数据。收集CHF患者和对照器官供者的星状神经节(SG)进行分子分析。平均(SD)CS NPY水平为85.1(31)pg/mL。在双变量分析中，CSNPY水平与估计的肾小球滤过率相关(r(S)=-0.36，P
Key PointsQuestionIs the adrenergic cotransmitter neuropeptide Y (NPY) associated with outcomes in patients with stable heart failure (HF)? FindingsIn a cohort of patients with stable HF undergoing cardiac resynchronization therapy device implantation, coronary sinus blood was sampled for NPY levels. A threshold level of NPY was identified, which was associated with death, heart transplant, and ventricular assist device placement; molecular studies on human sympathetic neurons indicated increased release of NPY in HF patients. MeaningUsing NPY, hyperadrenergic activation associated with adverse outcomes may be identifiable in patients with stable HF.ImportanceChronic heart failure (CHF) is associated with increased sympathetic drive and may increase expression of the cotransmitter neuropeptide Y (NPY) within sympathetic neurons. ObjectiveTo determine whether myocardial NPY levels are associated with outcomes in patients with stable CHF. Design, Setting, and ParticipantsProspective observational cohort study conducted at a single-center, tertiary care hospital. Stable patients with heart failure undergoing elective cardiac resynchronization therapy device implantation between 2013 and 2015. Main Outcomes and MeasuresChronic heart failure hospitalization, death, orthotopic heart transplantation, and ventricular assist device placement. ResultsCoronary sinus (CS) blood samples were obtained during cardiac resynchronization therapy (CRT) device implantation in 105 patients (mean [SD] age 68 [12] years; 82 men [78%]; mean [SD] left ventricular ejection fraction [LVEF] 26% [7%]). Clinical, laboratory, and outcome data were collected prospectively. Stellate ganglia (SG) were collected from patients with CHF and control organ donors for molecular analysis. Mean (SD) CS NPY levels were 85.1 (31) pg/mL. On bivariate analyses, CS NPY levels were associated with estimated glomerular filtration rate (eGFR; r(s)=-0.36, P