BACKGROUND Both BNP (B-type natriuretic peptide) and NT-proBNP (N-terminal pro B-type natriuretic peptide) are widely used to aid diagnosis, assess the effect of therapy, and predict outcomes in heart failure and reduced ejection fraction. However, little is known about how these 2 peptides compare in heart failure and reduced ejection fraction, especially with contemporary assays. Both peptides were measured at screening in the PARADIGM-HF trial (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure). METHODS Eligibility criteria in PARADIGM-HF included New York Heart Association functional class II to IV, left ventricular ejection fraction ≤40%, and elevated natriuretic peptides: BNP ≥150 pg/mL or NT-proBNP ≥600 pg/mL (for patients with HF hospitalization within 12 months, BNP ≥100 pg/mL or NT-proBNP ≥400 pg/mL). BNP and NT-proBNP were measured simultaneously at screening and only patients who fulfilled entry criteria for both natriuretic peptides were included in the present analysis. The BNP/NT-proBNP criteria were not different for patients in atrial fibrillation. Estimated glomerular filtration rate <30 mL/min per 1.73 m2 was a key exclusion criterion. RESULTS The median baseline concentration of NT-proBNP was 2067 (Q1, Q3: 1217-4003) and BNP 318 (Q1, Q3: 207-559), and the ratio, calculated from the raw data, was ≈6.25:1. This ratio varied considerably according to rhythm (atrial fibrillation 8.03:1; no atrial fibrillation 5.75:1) and with age, renal function, and body mass index but not with left ventricular ejection fraction. Each peptide was similarly predictive of death (all-cause, cardiovascular, sudden and pump failure) and heart failure hospitalization, for example, cardiovascular death: BNP hazard ratio, 1.41 (95% CI, 1.33-1.49) per 1 SD increase, P<0.0001; NT-proBNP, 1.45 (1.36-1.54); P<0.0001. CONCLUSIONS The ratio of NT-proBNP to BNP in heart failure and reduced ejection fraction appears to be greater than generally appreciated, differs between patients with and without atrial fibrillation, and increases substantially with increasing age and decreasing renal function. These findings are important for comparison of natriuretic peptide concentrations in heart failure and reduced ejection fraction.

中文翻译：

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心力衰竭和射血分数降低的患者中BNP和NT-proBNP的比较。

背景技术BNP（B型利钠肽）和NT-proBNP（N端原B型利尿肽）均被广泛用于辅助诊断，评估治疗效果并预测心力衰竭和射血分数降低的结果。然而，人们对这两种肽在心力衰竭和射血分数降低方面的比较知之甚少，尤其是在现代测定中。两种肽均在PARADIGM-HF试验中进行筛查（ARNI与ACEI的前瞻性比较，以确定对全球死亡率和心力衰竭发病率的影响）。方法PARADIGM-HF的入选标准包括纽约心脏协会功能性II至IV级，左心室射血分数≤40％和利钠钠肽升高：BNP≥150pg / mL或NT-proBNP≥600pg / mL（对于HF在12个月内住院，BNP≥100pg / mL或NT-proBNP≥400pg / mL）。在筛查时同时测量BNP和NT-proBNP，本分析仅包括满足两种利钠肽进入标准的患者。对于房颤患者，BNP / NT-proBNP标准无差异。估计的肾小球滤过率<30 mL / min / 1.73 m2是关键的排除标准。结果NT-proBNP的中位基线浓度为2067（Q1，Q3：1217-4003）和BNP 318（Q1，Q3：207-559），从原始数据计算得出的比率为≈6.25：1。该比率根据节律（房颤8.03：1；无房颤5.75：1），年龄，肾功能和体重指数而变化，但与左室射血分数无关。每种肽都可以类似地预测死亡（全因，心血管疾病，突发性疾病和泵衰竭）和心力衰竭住院，例如心血管死亡：BNP风险比，每增加1 SD就会增加1.41（95％CI，1.33-1.49），P <0.0001; NT-proBNP，1.45（1.36-1.54）；P ＜0.0001。结论在心力衰竭和射血分数降低的情况下，NT-proBNP与BNP的比例似乎比通常所理解的要大，在有和没有房颤的患者之间存在差异，并且随着年龄的增长和肾功能的下降而显着增加。这些发现对于比较心力衰竭和射血分数降低的利钠肽浓度很重要。结论在心力衰竭和射血分数降低的情况下，NT-proBNP与BNP的比例似乎比通常所理解的要大，在有和没有房颤的患者之间存在差异，并且随着年龄的增长和肾功能的下降而显着增加。这些发现对于比较心力衰竭和射血分数降低的利钠肽浓度很重要。结论在心力衰竭和射血分数降低的情况下，NT-proBNP与BNP的比例似乎比通常所理解的要大，在有和没有房颤的患者之间存在差异，并且随着年龄的增长和肾功能的下降而显着增加。这些发现对于比较心力衰竭和射血分数降低的利钠肽浓度很重要。