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Heart:美发现心衰危险分层的新生物标志物

2012-01-01 MedSci原创 MedSci原创

12月22日,美国研究者在Heart杂志发表的一项研究"Serial measurements of midregion proANP and copeptin in ambulatory patients with heart failure: incremental prognostic value of novel biomarkers in heart failure "表明,连续性监测M

12月22日,美国研究者在Heart杂志发表的一项研究"Serial measurements of midregion proANP and copeptin in ambulatory patients with heart failure: incremental prognostic value of novel biomarkers in heart failure "表明,连续性监测MR-proANP,以及影响较小的和肽素和肌钙蛋白T(cTnT)的策略,可能对于检测和干预最高危的心力衰竭院外患者有益。

心力衰竭的疾病进展反映了神经内分泌系统的紊乱,生物标志物可有助于诊断和评估患者预后。对于促尿钠排泄和加压素及C末端加压素前体等系统的一些前提肽的连续性测定可以增加心力衰竭卧床患者危险分层的价值。

该研究前瞻性纳入了187例心功能为Ⅲ~Ⅳ级的心力衰竭患者,在2年间每3个月检测生物标志物水平,并与死亡或移植共同进行分析。

时间依赖的分析表明,MR-proANP及和肽素水平的升高与危险升高相关,但是校正cTnT≥0.01 ng/ml后的多变量分析表明,仅MR-proANP水平的升高是独立的预测因素,升高30%以上增加了鉴别最高危患者的价值。(生物谷Bioon.com)

Serial measurements of midregion proANP and copeptin in ambulatory patients with heart failure: incremental prognostic value of novel biomarkers in heart failure

Wayne L Miller1, Karen A Hartman1, Diane E Grill2, Joachim Struck3, Andreas Bergmann3, Allan S Jaffe1,4

Background Disease progression in heart failure (HF) reflects derangements in neurohormonal systems, and biomarkers of these systems can help to establish the diagnosis and assess the prognosis. Serial measurements of the precursor peptides of the natriuretic and vasopressin systems (midregional proatrial natriuretic peptide (MR-proANP) and C-terminal provasopressin (copeptin), respectively) should add incremental value to risk stratification in ambulatory patients with HF.
Methods and results A cohort of 187 patients with class III–IV HF was prospectively enrolled, with biomarkers collected every 3 months over 2 years and analysed in relation to death/transplantation. Time-dependent analyses (dichotomous and continuous variables) showed that increases in MR-proANP (HR 7.6, 95% CI 1.85 to 31.15, p<0.01) and copeptin (HR 2.7, 95% CI 1.27 to 5.61, p=0.01) were associated with increased risk, but, in multivariate analysis adjusted for troponin T (cTnT) ≥0.01 ng/ml, only raised MR-proANP remained an independent predictor (HR 5.49, 95% CI 1.31 to 23.01, p=0.02). Combined increases in MR-proANP and copeptin (HR 9.01, 95% CI 1.24 to 65.26, p=0.03) with cTnT (HR 11.1, 95% CI 1.52 to 80.85, p=0.02), and increases ≥30% above already raised values identified the patients at greatest risk (MR-proANP: HR 10.1, 95% CI 2.34 to 43.38, p=0.002; copeptin: HR 11.5, 95% CI 2.74 to 48.08, p<0.001).
Conclusions A strategy of serial monitoring of MR-proANP and, of lesser impact, copeptin, combined with cTnT, may be advantageous in detecting and managing the highest-risk outpatients with HF.

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    2012-01-03 zhaojie88
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    2012-01-03 slcumt
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