EUR HEART J：NT-proBNP有效预测肥厚型心肌病患者预后

　　英国学者的一项研究表明，在肥厚型心肌病（HCM）患者中，N端脑利钠肽前体（NT-proBNP）浓度升高为总体预后的有效预测因子。论文于2013年3月1日在线发表于《欧洲心脏杂志》（Eur Heart J）。

　　此项研究共纳入847例HCM患者。受试者年龄为53 ± 15岁，67%为男性，28%伴有静息左室流出道梗阻≥30 mmHg。中位随访时间为3.5年。主要终点为全因死亡或心脏移植。

　　结果显示，中位NT-proBNP浓度为78 pmol/L。8%（68例）的受试者达到主要终点。血浆NT-proBNP浓度可预测远期生存率。血清NT-proBNP浓度≥135 pmol/L与年度事件发生率6.1%相关。在多变量Cox模型中，NYHA分级III/IV（P = 0.008）、射血分数（P = 0.035）和log NT-proBNP（P < 0.001）为主要转归的独立预测因素。log NT-proBNP为心衰和移植相关性死亡的显著预测因子（P < 0.001），但无法预测猝死或ICD休克（P = 0.111）。在射血分数≥50%的患者中，log NT-proBNP仍为主要转归的主要预测因子（P < 0.001）。

与心肌病相关的拓展阅读：

• HEART RHYTHM :致心律失常性心肌病患者或存在心肌信号传导紊乱
• Circulation：肥厚性心肌病遗传外显率调查
• 靶向心肌重构与损伤 推进心肌病防治
• JBC：DES基因触发心律失常性右心室心肌病
• Nature：心脏血管生成失衡导致围产期心肌病
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Relation between serum N-terminal pro-brain natriuretic peptide and prognosis in patients with hypertrophic cardiomyopathy

Aims 

To determine the relation between serum concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) and prognosis in patients with hypertrophic cardiomyopathy (HCM).

Methods and results 

In total, 847 patients (53 ± 15 years; 67% male) with HCM (28% with left ventricular outflow tract obstruction ≥30 mmHg at rest) were followed for 3.5 years (IQR 2.5–4.5 years). The median NT-proBNP concentration was 78 pmol/L (range <5–1817 pmol/L and IQR 31−183 pmol/L). Sixty-eight patients (8%) reached the primary endpoint of all-cause mortality or cardiac transplantation. Plasma NT-proBNP concentration predicted long-term survival from the primary endpoint [area under the receiver operating characteristic curve of 0.78 (95% confidence interval 0.73−0.84)]. A serum concentration of ≥135 pmol/L was associated with an annual event rate of 6.1% (95% CI 4.4−7.7). Three independent predictors of primary outcome were identified in a multivariable Cox model: New York Heart Association class III/IV (HR 2.10, 95% CI 1.21−3.65, P = 0.008), ejection fraction (HR 0.98, 95% CI 0.96−1.00, P = 0.035), log NT-proBNP (HR 2.04, 95% CI 1.56−2.66, P < 0.001). Log NT-proBNP was a significant predictor of heart failure (HF) and transplant-related deaths (n = 23; HR 3.03, 95% CI 1.99−4.60, P < 0.001) but not sudden death or appropriate implantable cardioverter defibrillator shock (n = 11; HR 1.54, 95% CI 0.91−2.60, P = 0.111). In patients with ejection fraction ≥50% (n = 673), log NT-proBNP remained an independent predictor of the primary outcome (HR 2.11, 95% CI 1.54−2.90, P < 0.001).

Conclusion 

In patients with HCM, elevated NT-proBNP concentration is a strong predictor of overall prognosis, particularly HF-related death and transplantation.