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HFrEF患者NT-proBNP浓度变化与心容量和心功能变化的关系
作者:小柯机器人 发布时间:2019/9/4 17:35:03

美国麻省综合医院的James L. Januzzi与合作者在新研究中,分析了用Sacubitril-缬沙坦治疗射血分数降低型心力衰竭(HFrEF)患者N末端B型钠尿肽前体(NT-proBNP)浓度的变化是否与心容量和心功能的变化有关。相关论文2019年9月2日在线发表于《美国医学会杂志》。

2016年10月25日至2018年10月22日,这项前瞻性、12个月、单组、开放标签的研究在美国78个门诊点共招募了794名HFrEF患者,平均年龄为65.1岁,平均左室射血分数(LVEF)为28.2%。最初使用Sacubitril-缬沙坦进行治疗,后续调整剂量,共有654名(82.4%)参与者完成试验。

基线时的NT-proBNP中位浓度为816 pg/mL,12个月时为455 pg/mL,差异显著。log2-NT-proBNP浓度的变化与LVEF负相关,与左室舒张末期容积指数(LVEDVI)、左室收缩末期容积指数(LVESVI)、左房容积指数(LAVI)和二尖瓣e/e′比值呈正相关。LVEF从28.2%增加到37.8%,而LVEDVI从86.93下降到74.15 mL/m2,LVESVI从61.68下降到45.46 mL/m2,差异均具有统计学意义。

研究人员总结说,在这项探索性的研究中,应用Sacubitril-缬沙坦治疗HFrEF患者,NT-proBNP浓度的降低与12个月时心容量和心功能指标的改善呈弱而显著的相关。

附:英文原文

Title: Association of Change in N-Terminal Pro–B-Type Natriuretic Peptide Following Initiation of Sacubitril-Valsartan Treatment With Cardiac Structure and Function in Patients With Heart Failure With Reduced Ejection Fraction

Author: James L. Januzzi Jr, MD1,2; Margaret F. Prescott, PhD3; Javed Butler, MD, MPH, MBA4; G. Michael Felker, MD, MHS5; Alan S. Maisel, MD6; Kevin McCague, MA3; Alexander Camacho, PhD1; Ileana L. Piña, MD, MPH7; Ricardo A. Rocha, MD3; Amil M. Shah, MD, MPH8; Kristin M. Williamson, PharmD3; Scott D. Solomon, MD8; for the PROVE-HF Investigators

Issue&Volume: September 2, 2019

Abstract:

Importance  In patients with heart failure and reduced ejection fraction (HFrEF), treatment with sacubitril-valsartan reduces N-terminal pro–b-type natriuretic peptide (NT-proBNP) concentrations. The effect of sacubitril-valsartan on cardiac remodeling is uncertain.

Objective  To determine whether NT-proBNP changes in patients with HFrEF treated with sacubitril-valsartan correlate with changes in measures of cardiac volume and function.

Design, Setting, and Participants  Prospective, 12-month, single-group, open-label study of patients with HFrEF enrolled in 78 outpatient sites in the United States. Sacubitril-valsartan was initiated and the dose adjusted. Enrollment commenced on October 25, 2016, and follow-up was completed on October 22, 2018.

Exposures  NT-proBNP concentrations among patients treated with sacubitril-valsartan.

Main Outcomes and Measures  The primary outcome was the correlation between changes in log2–NT-proBNP concentrations and left ventricular (LV) EF, LV end-diastolic volume index (LVEDVI), LV end-systolic volume index (LVESVI), left atrial volume index (LAVI), and ratio of early transmitral Doppler velocity/early diastolic annular velocity (E/e′) at 12 months.

Results  Among 794 patients (mean age, 65.1 years; 226 women [28.5%]; mean LVEF = 28.2%), 654 (82.4%) completed the study. The median NT-proBNP concentration at baseline was 816 pg/mL (interquartile range [IQR], 332-1822) and 455 pg/mL (IQR, 153-1090) at 12 months (difference, P < .001). At 12 months, the change in log2–NT-proBNP concentration was correlated with changes in LVEF (r = −0.381 [IQR, −0.448 to −0.310]; P < .001), LVEDVI (r = 0.320 [IQR, 0.246 to 0.391]; P < .001), LVESVI (r = 0.405 [IQR, 0.335 to 0.470]; P < .001), LAVI (r = 0.263 [IQR, 0.186 to 0.338]; P < .001), and E/e′ (r = 0.269 [IQR, 0.182 to 0.353]; P < .001). At 12 months, LVEF increased from 28.2% to 37.8% (difference, 9.4% [95% CI, 8.8% to 9.9%]; P < .001), while LVEDVI decreased from 86.93 to 74.15 mL/m2 (difference, −12.25 mL/m2 [IQR, −12.92 to −11.58]; P < .001) and LVESVI decreased from 61.68 to 45.46 mL/m2 (difference, −15.29 mL/m2 [95% CI, −16.03 to −14.55]; P < .001). LAVI and E/e′ ratio also decreased significantly. The most frequent adverse events were hypotension (17.6%), dizziness (16.8%), hyperkalemia (13.2%), and worsening kidney function (12.3%).

Conclusions and Relevance  In this exploratory study of patients with HFrEF treated with sacubitril-valsartan, reduction in NT-proBNP concentration was weakly yet significantly correlated with improvements in markers of cardiac volume and function at 12 months. The observed reverse cardiac remodeling may provide a mechanistic explanation for the effects of sacubitril-valsartan in patients with HFrEF.

期刊信息

JAMA-Journal of The American Medical Association:《美国医学会杂志》,创刊于1883年。隶属于美国医学协会,最新IF:51.273
官方网址:https://jamanetwork.com/
投稿链接:http://manuscripts.jama.com/cgi-bin/main.plex