射血分数轻度降低或保留的心力衰竭患者的利钠肽、体重指数和临床结局。

IF 22.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
John W Ostrominski, Brendon L Neuen, Brian L Claggett, Inder S Anand, Akshay S Desai, Pardeep S Jhund, Carolyn S P Lam, Marc A Pfeffer, Bertram Pitt, Faiez Zannad, Michael R Zile, Milton Packer, Kieran F Docherty, John J V McMurray, Scott D Solomon, Muthiah Vaduganathan
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引用次数: 0

摘要

背景:利钠肽是心力衰竭(HF)指南中推荐的主要生物标志物,用于临床实践中对患者进行风险分层,并作为当代临床试验的关键资格标准。然而,阈值水平通常不考虑肥胖的衡量标准,如身体质量指数(BMI)。目的:评估n端前b型利钠肽(NT-proBNP)与心衰和射血分数轻度降低或保留(HFmrEF/HFpEF)患者临床结局之间的关系,并根据BMI进行分层。方法:在这项纳入HFmrEF/HFpEF成人患者的4项全球随机结局试验的参与者水平汇总分析中,NT-proBNP与临床结局(心血管死亡或HF住院、心血管死亡、HF住院和全因死亡)之间的相关性根据BMI作为连续和分类变量进行评估。结果:在14,750名参与者中(平均年龄72±9岁,50%为女性,平均BMI为30±6 kg/m2,中位NT-proBNP为836 pg/mL),较高的基线BMI与较低的NT-proBNP水平显著且非线性相关。在中位随访2.8年期间,基线NT-proBNP每增加一倍,经协变量调整的心血管死亡或心衰住院率就会增加40%(风险比为1.40;95% CI为1.36-1.43;相互作用p =0.008)。对于相同的心血管死亡或HF住院绝对风险(每100人年5次事件),BMI≥35 kg/m2 (158 pg/mL)的非房颤参与者的NT-proBNP水平比2 (450 pg/mL)低近3倍。在当代基于nt - probnp的试验资格阈值中,心血管死亡或HF住院的绝对风险在BMI为2的人群中为3.5 / 100人年,在BMI≥40 kg/m2的人群中为7.3 / 100人年。结论:在本分析中,目前的NT-proBNP阈值大大低估了BMI较高人群发生HF不良结局的绝对风险。这些数据对单一的固定阈值提出了质疑,并表明较低的NT-proBNP临界值可能更适合对BMI较高的患者进行风险分层。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Natriuretic Peptides, Body Mass Index, and Clinical Outcomes in Heart Failure With Mildly Reduced or Preserved Ejection Fraction.

Background: Natriuretic peptides are the primary biomarkers recommended in heart failure (HF) guidelines to risk stratify patients in clinical practice and serve as key eligibility criteria in contemporary clinical trials. However, threshold levels typically do not account for measures of adiposity, such as body mass index (BMI).

Objective: The purpose of this study was to evaluate the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) with clinical outcomes in individuals with heart failure and mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), stratified according to BMI.

Methods: In this participant-level pooled analysis of 4 global, randomized, outcomes trials including adults with HFmrEF/HFpEF, the association between NT-proBNP and clinical outcomes (cardiovascular death or HF hospitalization, cardiovascular death, and all-cause death) was evaluated according to BMI as a continuous and categorical variable.

Results: Among 14,750 participants (mean age, 72 ± 9 years; 50% female; mean BMI, 30 ± 6 kg/m2; median NT-proBNP, 836 pg/mL), higher baseline BMI was significantly and nonlinearly associated with lower NT-proBNP levels. Over a median follow-up of 2.8 years, each doubling of baseline NT-proBNP was associated with a 40% higher covariate-adjusted rate of cardiovascular death or HF hospitalization (HR: 1.40; 95% CI: 1.36-1.43; P < 0.001); however, this association appeared incrementally blunted with higher baseline BMI (Pinteraction = 0.008). For the same absolute risk of cardiovascular death or HF hospitalization (5 events per 100 person-years), NT-proBNP levels in participants without atrial fibrillation were nearly 3-fold lower among those with BMI ≥35 kg/m2 (158 pg/mL) vs <35 kg/m2 (450 pg/mL). At a contemporary NT-proBNP-based trial eligibility threshold, absolute risk of cardiovascular death or HF hospitalization ranged from 3.5 per 100 person-years among persons with BMI <30 kg/m2 to 7.3 per 100 person-years among those with BMI ≥40 kg/m2.

Conclusions: In this analysis, current NT-proBNP thresholds substantially underestimated the absolute risk of adverse HF outcomes among persons with higher BMI. These data question single fixed thresholds and instead suggest that lower NT-proBNP cutoffs may more appropriately risk stratify patients with higher BMI. (Irbesartan in Heart Failure and Preserved Ejection Fraction [I-PRESERVE], NCT00095238; Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist [TOPCAT], NCT00094302; Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor with Angiotensin Receptor Blocker Global Outcomes in HF with Preserved Ejection Fraction [PARAGON-HF], NCT01920711; Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure [DELIVER], NCT03619213).

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来源期刊
CiteScore
42.70
自引率
3.30%
发文量
5097
审稿时长
2-4 weeks
期刊介绍: The Journal of the American College of Cardiology (JACC) publishes peer-reviewed articles highlighting all aspects of cardiovascular disease, including original clinical studies, experimental investigations with clear clinical relevance, state-of-the-art papers and viewpoints. Content Profile: -Original Investigations -JACC State-of-the-Art Reviews -JACC Review Topics of the Week -Guidelines & Clinical Documents -JACC Guideline Comparisons -JACC Scientific Expert Panels -Cardiovascular Medicine & Society -Editorial Comments (accompanying every Original Investigation) -Research Letters -Fellows-in-Training/Early Career Professional Pages -Editor’s Pages from the Editor-in-Chief or other invited thought leaders
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