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首页> 外文期刊>The American Journal of Cardiology >Long-Term Prognostic Significance of Plasma B-Type Natriuretic Peptide Level in Patients With Acute Heart Failure With Reduced, Mid-Range, and Preserved Ejection Fractions
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Long-Term Prognostic Significance of Plasma B-Type Natriuretic Peptide Level in Patients With Acute Heart Failure With Reduced, Mid-Range, and Preserved Ejection Fractions

机译：急性心力衰竭患者急性心力衰竭减少，中档和保存的喷射分数的长期预后意义

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Plasma B-type natriuretic peptide (BNP) is an important prognostic marker in patients with acute heart failure (AHF). However, it is unclear which BNP parameter, on admission, at discharge, or change during hospitalization, has the highest predictive performance for long-term adverse outcomes, and whether its prognostic impact differs according to the new European heart failure (HF) phenotype classification by left ventricular ejection fraction: heart failure with reduced ejection fraction (HFrEF), heart failure with mid-range ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFpEF). We examined 1,792 patients with AHF consisting of 860 (48%) HFrEFs, 318 (18%) HFmrEFs, and 614 (34%) HFpEFs. Prognostic performance of each BNP parameter was assessed by the Harrell c-index. During a median follow-up of 664 days, 344 (19%) patients died. Discharge BNP had the highest c-index (0.69) for mortality among all BNP parameters (p 0.001). In multivariate Cox proportional hazard modeling, discharge BNP was associated with mortality in HFrEF, HFmrEF, and HFpEF patients with significant interaction (hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.57 to 2.41; HR 1.76, 95% CI 1.10 to 2.82; HR 1.46, 95% CI 1.12 to 1.91, respectively; p = 0.011 for interaction). Moreover, the c-index of discharge BNP for mortality in HFrEF patients (0.72) was higher than that in HFmrEF patients (0.68) and HFpEF patients (0.65). Similar results were obtained for mortality or HF rehospitalization as alternative outcomes, except there was no statistically significant interaction among HF phenotypes. In conclusion, discharge BNP is a more reliable marker than other BNP parameters on long-term outcome prediction in patients with AHF, but its prognostic impact may be weakened in HFmrEF and HFpEF compared with HFrEF. (C) 2017 Elsevier Inc. All rights reserved.
机译：血浆B型利钠肽（BNP）是急性心力衰竭（AHF）患者中的重要预后标志物。但是，目前尚不清楚在住院期间的放电或改变时的BNP参数具有最高的可预测性能，可根据新的欧洲心力衰竭（HF）表型分类而不同的预测性能，以及其预后的影响是否不同通过左心室喷射分数：具有减少的喷射级分（HFREF）的心力衰竭，心力衰竭与中档喷射级分（HFMREF），并具有保存的喷射部分（HFPEF）的心力衰竭。我们检查了1,792名AHF患者，由860（48％）HFREFS，318（18％）HFMREF和614（34％）HFPEF组成。通过Harrell C-Inde评估每个BNP参数的预后性能。在664天的中位随访期间，344名（19％）患者死亡。放电BNP在所有BNP参数中具有最高的C折射率（0.69），在所有BNP参数中进行死亡率（P <0.001）。在多变量Cox比例危险建模中，放电BNP与HFREF，HFMREF和HFPEF患者的死亡率有关（危害比[HR] 1.95,95％，95％置信区间[CI] 1.57至2.41; HR 1.76,95％CI 1.10至2.82; HR 1.46,95％CI 1.12至1.91分别; P = 0.011用于相互作用）。此外，HFREF患者中死亡率（0.72）的降低BNP的C折射率高于HFMREF患者（0.68）和HFPEF患者（0.65）。在替代结果中获得了类似的结果，以获得死亡率或HF再次生长，除了HF表型中没有统计学上显着的相互作用。总之，放电BNP是比AHF患者长期结果预测的其他BNP参数更可靠的标记，但与HFREF相比，其预后的影响可能在HFMREF和HFPEF中削弱。 （c）2017年Elsevier Inc.保留所有权利。

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