收稿日期: 2024-04-01
录用日期: 2024-05-15
网络出版日期: 2024-06-25
基金资助
国家自然科学基金青年项目(81500196)
Association between NT-proBNP and new-onset atrial fibrillation in patients with ischemic heart failure
Received date: 2024-04-01
Accepted date: 2024-05-15
Online published: 2024-06-25
目的:分析缺血性心力衰竭(心衰)患者的血浆N端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)水平,及其与患者新发心房颤动(房颤)间的关系。方法:本研究纳入120例射血分数降低(<40%)的窦性心律的缺血性心衰患者,分别在基线0 d、6个月和12个月测定其血浆NT-proBNP水平,并在入组时行超声心动图检查,于入组后1、3、6、12个月时进行24 h动态心电图检查,根据随访12个月中是否发生房颤,将患者分为房颤组(n=44)和无房颤组(n=76)。分析2组患者的临床资料和心动超声图资料,应用受试者操作特征(receiver operating characteristic, ROC)曲线,分析NT-proBNP检测对新发房颤的预测作用及其最佳临界值。采用多因素logistic回归分析NT-proBNP与缺血性心衰患者新发房颤间的关系。结果:在12个月的随访期间,缺血性心衰患者中新发房颤率为36.7%。与无房颤组相比,房颤组的纽约心功能分级、NT-proBNP水平(入组当天、6个月和12个月)、心动超声检查中二尖瓣口舒张早期/舒张晚期峰值速度比值(E/A)、二尖瓣口/二尖瓣环速度比值(E/E’)、肺动脉收缩压(pulmonary artery systolic pressure, PASP)、肺毛细血管楔嵌压(pulmonary capillary wedge pressure, PCWP)、左心房容量(left atrial volume, LAV)和左心房容量指数(left atrial volume index,LAVI)更高(P<0.05)。NT-proBNP与E/A、E/E’、PASP、PCWP、LAV和LAVI呈显著正相关(P<0.05)。ROC曲线显示,基线0 d的NT-proBNP水平对新发房颤的预测能力最强,临界值取NT-proBNP≥2 357.5 pg/mL时,其预测新发房颤的灵敏度为69%,特异度为83%,ROC曲线下面积为0.825(95%CI为0.722~0.924,P<0.001)。回归分析发现,仅NT-proBNP是缺血性心衰患者新发房颤的独立预测因子(OR=1.24,95%CI为1.08~1.43)(P=0.001)。结论:血浆NT-proBNP水平检测在预测缺血性心衰患者新发房颤中有一定的临床价值。
罗晓颖 , 章安迪 , 许燕 , 吴立群 , 戚文航 . 缺血性心力衰竭患者N端脑钠肽前体与新发房颤的相关性研究[J]. 诊断学理论与实践, 2024 , 23(03) : 313 -317 . DOI: 10.16150/j.1671-2870.2024.03.009
Objective To investigate the association between N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and the incidence of new-onset atrial fibrillation (AF) in patients with ischemic heart failure. Methods This study involved 120 patients with ischemic heart failure, characterized by sinus rhythm and a reduced ejection fraction (EF < 40%). NT-proBNP levels were measured at baseline, 6 months, and 12 months. At the 12-month follow-up, patients underwent 12-lead electrocardiography (EKG) or Holter monitoring to identify new-onset AF. Patients were classified into an AF group (n=44) and a non-AF group (n=76). Clinical characteristics and echocardiographic data were reviewed. Receiver operating characteristic (ROC) curves were employed to ascertain the optimal NT-proBNP threshold for predicting new-onset AF, and logistic regression analysis was used to evaluate the prognostic impact of NT-proBNP levels. Results New-onset AF was detected in 36.7% of the cohort. Significant elevations in functional capacity (NYHA class), NT-proBNP levels, E/A ratio, E/E' ratio, pulmonary artery systolic pressure (PASP), pulmonary capillary wedge pressure (PCWP), left atrial volume (LAV), and left atrial volume index (LAVI) were observed in the AF group compared to the non-AF group (P<0.05). NT-proBNP levels demonstrated positive correlations with these echocardiographic parameters (P<0.05). ROC curve analysis identified a baseline NT-proBNP cutoff value of 2357 pg/mL as the most predictive of new-onset AF, with 69% sensitivity and 83% specificity (AUC = 0.825, 95% CI: 0.722-0.924, P<0.001). Logistic regression analysis further established NT-proBNP as the only independent predictive predictor of new-onset AF (OR = 1.24, 95% CI: 1.08-1.43, P=0.001). Conclusions Serum NT-proBNP level is of certain value in prediction of the new-onset AF in patients with ischemic heart failure.
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