N末端B型利钠肽原在植入磁液悬浮左心室辅助装置终末期心衰患者中应用价值初探

A preliminary study of the value of N-terminal pro-B-type natriuretic peptide in patients with end-stage heart failure implanted with magnetic fluid suspended left ventricular assist devices

目的探讨终末期心衰(ESHF)患者在植入HeartCon型左心室辅助装置(LVAD)术前和术后N末端B型利钠肽原(NT-proBNP)的变化及对预测心脏不良事件的作用。方法回顾性研究, 连续选取2020年9月15日至2023年6月20日在泰达国际心血管病医院住院治疗植入HeartCon型LVAD的ESHF患者30例, 其中男23例, 女7例, 年龄54.5(40.8, 60.0)岁。分析其临床资料, 测量其术前水平和随访期内血液样本中NT-proBNP浓度。对患者定期随访, 记录出院后6个月内主要不良心脏事件, 包括心源性死亡和右心衰再住院;Logistic回归进行预后分析, ROC曲线评估NT-proBNP对LVAD患者不良预后的辅助诊断价值。通过对NT-proBNP诊断不良预后的临界值分成两组, 用Kaplan-Meier进行生存分析, 并用Log Rank检验;Cox回归分析随访6个月高水平NT-proBNP是否为LVAD患者不良预后的危险因素。结果成功植入HeartCon型LVAD的30例ESHF患者术前NT-proBNP中位水平达到3 251.0(1 544.5, 6 401.5)pg/ml, 在植入后第7天下降(3 251.0 比 1 815.0 pg/ml, P<0.05), 之后下降趋势逐渐变缓, 术后第90天下降到1 182.0(620.0, 3 385.3)pg/ml。术前NT-proBNP>3 251.0 pg/ml组患者术后住院时间更长(47 d 比 33 d, Z=-2.138, P=0.032)。多因素 Logistic 回归分析发现仅术后第7天NT-proBNP是LVAD患者术后预后不良的预测指标, OR值为1.001(P=0.011);ROC曲线分析术后第7天NT-proBNP水平对不良预后的辅助诊断价值(cut-off 值为2 083.0 pg/ml), AUC 为0.833(P=0.002);根据临界值分组, Kaplan-Meier 生存分析结果显示术后第7天NT-proBNP>2 083.0 pg/ml组的6个月内发生心脏不良事件时间明显短于NT-proBNP≤2 083.0 pg/ml组差异有统计学意义(3.538±0.689比5.471±0.323个月, P=0.004);Cox回归分析显示术后第7天NT-proBNP>2 083.0 pg/ml组心脏不良事件风险是NT-proBNP≤2 083.0 pg/ml组的4.25倍(HR=4.25, P=0.035)。结论 HeartCon型LVAD患者术前NT-proBNP水平越高术后住院时间越长。术后第7天NT-proBNP水平下降最明显, 术后第7天NT-proBNP水平是心脏不良事件发生的危险因子, 可作为植入LVAD的终末期心衰患者预后不良事件的预测因素。

Objective To investigate the changes in N-terminal pro-B-type natriuretic peptide(NT-proBNP)and its role in predicting major adverse cardiac events(MACEs)in patients with end-stage heart failure(ESHF)before and after implanted a HeartCon left ventricular assist device(LVAD).Methods The retrospective study included 30 ESHF patients[23 males and 7 females,aged 54.5(40.8,60.0)years],who were admitted to TEDA International Cardiovascular Disease Hospital from September 15,2020 to June 20,2023 to receive treatment with HeartCon LVAD implantation.Their clinical data were analyzed and NT-proBNP concentrations in their blood samples were measured preoperatively and during the follow-up period.Patients were followed regularly and MACEs,including cardiac death and rehospitalization for right heart failure,were recorded within 6 months of discharge;Logistic regression was used for prognostic analysis,and Receiver Operator Characteristic(ROC)curves were used to assess the adjunctive diagnostic value of NT-proBNP for poor prognosis in LVAD patients.The cut-off values for diagnosing poor prognosis by NT-proBNP were divided into two groups,and survival analysis was performed by Kaplan-Meier and tested by log rank;Cox regression was performed to analyze whether high levels of NT-proBNP at 6 months of follow-up wsa a risk factor for poor prognosis in patients with LVAD.Results The median preoperative NT-proBNP level in 30 ESHF patients successfully implanted with HeartCon LVADs was 3251.0(1544.5,6401.5)pg/ml.It decreased significantly 7 days postoperatively(3251.0 vs.1815.0 pg/ml,P<0.05),and then the decreasing trend slowed.It decreased to 1182.0(620.0,3385.3)pg/ml on the 90th post-operative day.The preoperative NT-proBNP>3251.0 pg/ml group had a longer postoperative hospital stay(47 d vs 33 d,Z=-2.138,P=0.032).Multivariate logistic regression analysis,only NT-proBNP at 7 days postoperatively was found to predict poor prognosis in LVAD patients,with an OR of 1.001(P=0.01);ROC curves were analyzed for the adjunctive diagnostic value of 7-day postoperative NT-proBNP levels for poor prognosis(cut-off value of 2083.0 pg/ml),with an AUC of 0.833(P=0.002);The Kaplan-Meier survival analysis showed that the time to MACEs within 6 months was significantly shorter in the group with NT-proBNP>2083.0 pg/mL on postoperative day 7 than in the group with NT-proBNP≤2083.0 pg/ml(3.538±0.689 vs.5.471±0.323 months,P=0.004);Cox regression analysis showed that the risk of MACEs was 4.25 times higher in the 7-day postoperative NT-proBNP>2083.0 pg/ml group than in the NT-proBNP≤2083.0 pg/ml group(HR=4.25,P=0.035).Conclusions The higher the preoperative NT-proBNP level,the longer the postoperative hospital stay in HeartCon LVAD patients.NT-proBNP levels decrease most significantly on postoperative day 7 and is a risk factor for MACEs.It may be used as a prognostic predictor in ESHF patients with implanted LVADs.