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

Association between NT-proBNP and new-onset atrial fibrillation in patients with ischemic heart failure

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≥2357.5 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。

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 NTproBNP level is of certain value in prediction of the new-onset AF in patients with ischemic heart failure.