Effect of Intensive Blood Pressure Control on Troponin and Natriuretic Peptide Levels: Findings From SPRINT.
Effect of Intensive Blood Pressure Control on Troponin and Natriuretic Peptide Levels: Findings From SPRINT.
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强化血压控制对肌钙蛋白和利尿钠肽水平的影响：来自 SPRINT 的研究结果。
DOI：
10.1161/circulationaha.122.059960
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发表时间：
2023
期刊：
影响因子：
37.8
通讯作者：
deLemos,JamesA
中科院分区：
文献类型：
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作者：
Berry,JarettD;Chen,Haiying;Nambi,Vijay;Ambrosius,WalterT;Ascher,SimonB;Shlipak,MichaelG;Ix,JoachimH;Gupta,Rajesh;Killeen,Anthony;Toto,RobertD;Kitzman,DalaneW;Ballantyne,ChristieM;deLemos,JamesA
鉴于心脏损伤和神经激素激活在高血压到心力衰竭的通路中的重要作用，以及高血压与其后遗症之间的强相关性，hs-cTnT（高敏心肌肌钙蛋白T）和NT-proBNP（N-末端B型利钠肽原）水平，我们假设，强烈的收缩压（SBP）降低会降低hs-cTnT和NT-proBNP的水平。在SPRINT（收缩压干预试验）中，在基线和1年时从储存的标本中测量proBNP。在对数标度上并根据类别（增加≥50%、减少≥50%或变化<50%）连续评价生物标志物的变化。分别使用线性和多项式logistic回归模型评估了强化SBP降低对生物标志物水平连续和分类变化的影响。使用多变量校正的考克斯比例风险模型评估心力衰竭生物标志物变化与死亡之间的相关性。（与标准SBP管理相比）导致hs-cTnT水平在1年随访期间增加3%（几何均值比，1.03 [95% CI，1.01-1.04]）和增加≥50%的受试者比例较高（比值比，1.47 [95% CI，1.13，1.90]）。相比之下，随机化至强化SBP降低导致NT-proBNP降低10%（几何均值比，0.90 [95% CI，0.87-0.93]），NT-proBNP升高≥50%的概率较低（比值比，0.57 [95% CI，0.46-0.72]）。在考虑随访期间估计肾小球滤过率的变化后，随机治疗分配与hs-cTnT变化的相关性完全减弱，而在调整SBP变化后，与NT-proBNP治疗的相关性完全减弱。hs-cTnT和NT-proBNP从基线到1年的增加与心力衰竭和死亡的风险更高，没有显着的相互作用，通过治疗assignment.ConclusionsIntensive降低SBP增加hs-cTnT，介导的SBP降低对肾脏滤过减少的影响。相比之下，强化SBP降低可降低NT-proBNP，这一发现可通过SBP降低来解释。这些发现强调了影响心脏生物标志物变化的非心脏因素的重要性，并提出了关于hs-cTnT在降低SBP研究中作为心力衰竭或死亡替代标志物的潜在作用的问题。
BackgroundGiven the important role of cardiac injury and neurohormonal activation in the pathways leading from hypertension to heart failure and strong associations observed between hypertension and its sequelae on hs-cTnT (high-sensitivity cardiac troponin T) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, we hypothesized that intensive systolic blood pressure (SBP) lowering would decrease levels of hs-cTnT and NT-proBNP.Methodshs-cTnT and NT-proBNP were measured at baseline and 1 year from stored specimens in SPRINT (Systolic Blood Pressure Intervention Trial). Changes in biomarkers were evaluated continuously on the log scale and according to categories (≥50% increase, ≥50% decrease, or <50% change). The effect of intensive SBP lowering on continuous and categorical changes in biomarker levels were assessed using linear and multinomial logistic regression models, respectively. The association between changes in biomarkers on heart failure and death was assessed using multivariable-adjusted Cox proportional hazards models.ResultsRandomization to intensive SBP lowering (versus standard SBP management) resulted in a 3% increase in hs-cTnT levels over 1-year follow-up (geometric mean ratio, 1.03 [95% CI, 1.01–1.04]) and a higher proportion of participants with ≥50% increase (odds ratio, 1.47 [95% CI, 1.13, 1.90]). In contrast, randomization to intensive SBP lowering led to a 10% decrease in NT-proBNP (geometric mean ratio, 0.90 [95% CI, 0.87–0.93]) and a lower probability of ≥50% increase in NT-proBNP (odds ratio, 0.57 [95% CI, 0.46–0.72]). The association of randomized treatment assignment on change in hs-cTnT was completely attenuated after accounting for changes in estimated glomerular filtration rate over follow-up, whereas the association of treatment with NT-proBNP was completely attenuated after adjusting for change in SBP. Increases in hs-cTnT and NT-proBNP from baseline to 1 year were associated with higher risk for heart failure and death, with no significant interactions by treatment assignment.ConclusionsIntensive SBP lowering increased hs-cTnT, mediated by the effect of SBP lowering on reduced kidney filtration. In contrast, intensive SBP lowering decreased NT-proBNP, a finding that was explained by the decrease in SBP. These findings highlight the importance of noncardiac factors influencing variation in cardiac biomarkers and raise questions about the potential role of hs-cTnT as a surrogate marker for heart failure or death in SBP-lowering studies.
计算机辅助断层扫描：累及眼眶的鼻窦病变。
DOI：
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发表时间：
1980
期刊：
Head & Neck Surgery
影响因子：
--
作者：
L. Bilaniuk;R. Zimmerman
通讯作者：
R. Zimmerman
影响因子：
19.7
作者：
P. Som;W. Lawson;H. Biller;C. Lanzieri
通讯作者：
C. Lanzieri
自动化 MR 成像方案可提高患者吞吐量。
DOI：
10.1016/0895-6111(88)90001-8
发表时间：
1988
期刊：
Computerized medical imaging and graphics : the official journal of the Computerized Medical Imaging Society
影响因子：
--
作者：
Lufkin,R;Dworkin,J;Stutman,J;Cohen,J;Wolf,R;Shenoy,R;Hanafee,W
通讯作者：
Hanafee,W