NT-proBNP for Risk Prediction in Heart Failure,JACC: Heart Failure

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NT-proBNP for Risk Prediction in Heart Failure
JACC: Heart Failure ( IF 13.0 ) Pub Date : 2021-07-07 , DOI: 10.1016/j.jchf.2021.05.014
Giuseppe Vergaro ₁ , Francesco Gentile ₂ , Laura M G Meems ₃ , Alberto Aimo ₄ , James L Januzzi ₅ , A Mark Richards ₆ , Carolyn S P Lam ₇ , Roberto Latini ₈ , Lidia Staszewsky ₈ , Inder S Anand ₉ , Jay N Cohn ₁₀ , Thor Ueland ₁₁ , Lars Gullestad ₁₂ , Pål Aukrust ₁₃ , Hans-Peter Brunner-La Rocca ₁₄ , Antoni Bayes-Genis ₁₅ , Josep Lupón ₁₅ , Akiomi Yoshihisa ₁₆ , Yasuchika Takeishi ₁₆ , Michael Egstrup ₁₇ , Ida Gustafsson ₁₇ , Hanna K Gaggin ₁₈ , Kai M Eggers ₁₉ , Kurt Huber ₂₀ , Greg D Gamble ₂₁ , Lieng H Ling ₂₂ , Kui Tong Gerard Leong ₂₃ , Poh Shuah Daniel Yeo ₂₄ , Hean Yee Ong ₂₅ , Fazlur Jaufeerally ₂₆ , Tze P Ng ₂₂ , Richard Troughton ₅ , Robert N Doughty ₂₁ , Gerry Devlin ₂₇ , Mayanna Lund ₂₈ , Alberto Giannoni ₁ , Claudio Passino ₁ , Rudolf A de Boer ₃ , Michele Emdin ₁

Affiliation

Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana G. Monasterio, Pisa, Italy.
Fondazione Toscana G. Monasterio, Pisa, Italy.
University Medical Centre Groningen, Groningen, the Netherlands.
Scuola Superiore Sant'Anna, Pisa, Italy.
Massachusetts General Hospital and Baim Institute for Clinical Research, Boston, Massachusetts, USA.
University of Otago, Dunedin, New Zealand.
National Heart Centre Singapore and Duke-National University of Singapore, Singapore.
IRCCS-Istituto di Ricerche Farmacologiche-"Mario Negri," IRCCS Milano, Italy.
University of Minnesota, Minneapolis, Minnesota, USA; VA Medical Centre, Minneapolis, Minnesota, USA.
University of Minnesota, Minneapolis, Minnesota, USA.
Oslo University Hospital, Ullevål, Oslo, Norway; Oslo University Hospital, Rikshospitalet, Oslo, Norway; University of Oslo, Oslo, Norway; University of Tromsø, Tromsø, Norway.
KG Jebsen Center for Cardiac Research, University of Oslo, and Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway.
Oslo University Hospital, Rikshospitalet, Oslo, Norway; University of Oslo, Oslo, Norway.
Maastricht University Medical Centre, Maastricht, the Netherlands.
Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona) and CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
Fukushima Medical University, Fukushima, Japan.
Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Uppsala University, Uppsala, Sweden.
Wilhelminenspital and Sigmund Freud University Medical School, Vienna, Austria.
University of Auckland, Auckland, New Zealand.
National University Heart Centre and National University of Singapore, Singapore.
Changi General Hospital, Singapore.
Tan Tock Seng Hospital, Singapore.
Khoo Teck Puat Hospital, Singapore.
Singapore General Hospital, Singapore.
Gisborne Hospital, Gisborne, New Zealand.
Middlemore Hospital, Auckland, New Zealand.

Objectives

The goal of this study was to assess the predictive power of N-terminal pro–B-type natriuretic peptide (NT-proBNP) and the decision cutoffs in heart failure (HF) across body mass index (BMI) categories.

Background

Concentrations of NT-proBNP predict outcome in HF. Although the influence of BMI to reduce levels of NT-proBNP is known, the impact of obesity on prognostic value remains uncertain.

Methods

Individual data from the BIOS (Biomarkers In Heart Failure Outpatient Study) consortium were analyzed. Patients with stable HF were classified as underweight (BMI <18.5 kg/m²), normal weight (BMI 18.5-24.9 kg/m²), overweight (BMI 25-29.9 kg/m²), and mildly (BMI 30-34.9 kg/m²), moderately (BMI 35-39.9 kg/m²), or severely (BMI ≥40 kg/m²) obese. The prognostic role of NT-proBNP was tested for the endpoints of all-cause and cardiac death.

Results

The study population included 12,763 patients (mean age 66 ± 12 years; 25% women; mean left ventricular ejection fraction 33% ± 13%). Most patients were overweight (n = 5,176), followed by normal weight (n = 4,299), mildly obese (n = 2,157), moderately obese (n = 612), severely obese (n = 314), and underweight (n = 205). NT-proBNP inversely correlated with BMI (β = –0.174 for 1 kg/m²; P < 0.001). Adding NT-proBNP to clinical models improved risk prediction across BMI categories, with the exception of severely obese patients. The best cutoffs of NT-proBNP for 5-year all-cause death prediction were lower as BMI increased (3,785 ng/L, 2,193 ng/L, 1,554 ng/L, 1,045 ng/L, 755 ng/L, and 879 ng/L, for underweight, normal weight, overweight, and mildly, moderately, and severely obese patients, respectively) and were higher in women than in men.

Conclusions

NT-proBNP maintains its independent prognostic value up to 40 kg/m² BMI, and lower optimal risk-prediction cutoffs are observed in overweight and obese patients.

中文翻译：

NT-proBNP 用于心力衰竭风险预测

目标

本研究的目的是评估 N 末端 B 型利钠肽前体 (NT-proBNP) 的预测能力和跨体重指数 (BMI) 类别的心力衰竭 (HF) 的决策截止值。

背景

NT-proBNP 浓度可预测 HF 的结果。虽然 BMI 对降低 NT-proBNP 水平的影响是已知的，但肥胖对预后价值的影响仍不确定。

方法

分析了来自 BIOS（心力衰竭门诊研究中的生物标志物）联盟的个人数据。稳定型心衰患者分为体重过轻（BMI <18.5 kg/m ²）、体重正常（BMI 18.5-24.9 kg/m ²）、超重（BMI 25-29.9 kg/m ²）和轻度（BMI 30-34.9 kg/m ²）、中度（BMI 35-39.9 kg/m ²）或严重（BMI ≥40 kg/m ²）肥胖。NT-proBNP 对全因和心源性死亡终点的预后作用进行了测试。

结果

研究人群包括 12,763 名患者（平均年龄 66 ± 12 岁；25% 女性；平均左心室射血分数 33% ± 13%）。大多数患者超重（n = 5,176），其次是体重正常（n = 4,299）、轻度肥胖（n = 2,157）、中度肥胖（n = 612）、重度肥胖（n = 314）和体重不足（n = 205））。NT-proBNP 与 BMI 呈负相关（β = –0.174 for 1 kg/m ² ; P <0.001)。将 NT-proBNP 添加到临床模型可改善 BMI 类别的风险预测，但严重肥胖的患者除外。5 年全因死亡预测 NT-proBNP 的最佳截断值随着 BMI 增加而降低（3,785 ng/L、2,193 ng/L、1,554 ng/L、1,045 ng/L、755 ng/L 和 879 ng /L，分别适用于体重过轻、正常体重、超重和轻度、中度和重度肥胖患者），女性高于男性。