OBJECTIVES: The aim of this study was to assess the predictive value of the cardiac hormone B- type natriuretic peptide(BNP) for long- term outcome in a large cohort of stable angina patients. BACKGROUND: Recent data ...OBJECTIVES: The aim of this study was to assess the predictive value of the cardiac hormone B- type natriuretic peptide(BNP) for long- term outcome in a large cohort of stable angina patients. BACKGROUND: Recent data suggest a role of BNP in stable ischemic heart disease beyond its known value in heart failure and acute coronary syndromes. METHODS: In 1,085 patients with coronary artery disease(CAD) baseline levels of BNP were prospectively associated with cardiovascular(CV) events during a mean follow- up of 2.5 years. RESULTS: BNP concentrations were significantly elevated in patients with future CV events(median [25th/75th interquartile range] 119.2 [43.6/300.4] pg/ml vs. 36.2 [11.3/94.6] pg/ml; p< 0.001). Kaplan- Meier survival analysis showed a stepwise decrease in event- free survival across quartiles of BNP baseline concentration(plogrank< 0.001). Patients in the highest quartile revealed a 6.1- fold increased risk(p=0.001) compared to patients in the lowest quartile after adjustment for potential confounders. For a cut- off value of 100 pg/ml, an independently increased risk of adverse outcome(hazard ratio [HR] 4.4; p< 0.001) could be demonstrated. One standard deviation(SD) decrease in ejection fraction implied the most prominent increase in risk of future CV events(HR 1.69; p< 0.001) followed by one SD increase in BNP(HR 1.53; p< 0.001). The highest prognostic accuracy could be demonstrated for BNP(area under the curve 0.671). CONCLUSIONS: The data of this large group of CAD patients provide independent evidence that BNP is a strong predictor of cardiovascular risk in patients with stable angina independent of left ventricular systolic performance and known risk factors.展开更多
Aims: Metalloproteinases are proteolytic enzymes, which decompose the extracellular matrix, influence cardiac remodelling, and are inhibited by tissue inhibitor of metalloproteinases(TIMPs). Little is known about the ...Aims: Metalloproteinases are proteolytic enzymes, which decompose the extracellular matrix, influence cardiac remodelling, and are inhibited by tissue inhibitor of metalloproteinases(TIMPs). Little is known about the prognostic impact of the TIMP-1/matrix metalloproteinase complex in patients with future cardiovascular death. Methods and results: In 1979 patients with suspected coronary artery disease(CAD), TIMP-1 has been determined at baseline. Among 1945(98.4% ) patients with a mean follow-up period of 2.6± 1.2 years, 75 patients died because of cardiovascular causes. Mean concentrations of TIMP-1 were higher among patients who experienced a fatal cardiovascular event than among those who did not(820 vs. 692 ng/mL; P < 0.001). Age and sex adjusted hazard ratio of future cardiovascular death associated with one standard deviation of TIMP-1 level, was 1.37(95% CI: 1.17- 1.61; P < 0.001). The hazard ratio remained nearly identical after adjustment for clinical and therapeutic confounders. B-type natriuretic peptide(2.75, 95% CI: 1.94- 3.89; P < 0.001), C-reactive protein(1.79, 95% CI: 1.43- 2.24; P < 0.001), and TIMP-1(1.30, 95% CI: 1.07- 1.58; P=0.008) were independently associated with future cardiovascular death. Conclusion: In patients with CAD, TIMP-1 proves as an independent predictor for future cardiovascular death.展开更多
文摘OBJECTIVES: The aim of this study was to assess the predictive value of the cardiac hormone B- type natriuretic peptide(BNP) for long- term outcome in a large cohort of stable angina patients. BACKGROUND: Recent data suggest a role of BNP in stable ischemic heart disease beyond its known value in heart failure and acute coronary syndromes. METHODS: In 1,085 patients with coronary artery disease(CAD) baseline levels of BNP were prospectively associated with cardiovascular(CV) events during a mean follow- up of 2.5 years. RESULTS: BNP concentrations were significantly elevated in patients with future CV events(median [25th/75th interquartile range] 119.2 [43.6/300.4] pg/ml vs. 36.2 [11.3/94.6] pg/ml; p< 0.001). Kaplan- Meier survival analysis showed a stepwise decrease in event- free survival across quartiles of BNP baseline concentration(plogrank< 0.001). Patients in the highest quartile revealed a 6.1- fold increased risk(p=0.001) compared to patients in the lowest quartile after adjustment for potential confounders. For a cut- off value of 100 pg/ml, an independently increased risk of adverse outcome(hazard ratio [HR] 4.4; p< 0.001) could be demonstrated. One standard deviation(SD) decrease in ejection fraction implied the most prominent increase in risk of future CV events(HR 1.69; p< 0.001) followed by one SD increase in BNP(HR 1.53; p< 0.001). The highest prognostic accuracy could be demonstrated for BNP(area under the curve 0.671). CONCLUSIONS: The data of this large group of CAD patients provide independent evidence that BNP is a strong predictor of cardiovascular risk in patients with stable angina independent of left ventricular systolic performance and known risk factors.
文摘Aims: Metalloproteinases are proteolytic enzymes, which decompose the extracellular matrix, influence cardiac remodelling, and are inhibited by tissue inhibitor of metalloproteinases(TIMPs). Little is known about the prognostic impact of the TIMP-1/matrix metalloproteinase complex in patients with future cardiovascular death. Methods and results: In 1979 patients with suspected coronary artery disease(CAD), TIMP-1 has been determined at baseline. Among 1945(98.4% ) patients with a mean follow-up period of 2.6± 1.2 years, 75 patients died because of cardiovascular causes. Mean concentrations of TIMP-1 were higher among patients who experienced a fatal cardiovascular event than among those who did not(820 vs. 692 ng/mL; P < 0.001). Age and sex adjusted hazard ratio of future cardiovascular death associated with one standard deviation of TIMP-1 level, was 1.37(95% CI: 1.17- 1.61; P < 0.001). The hazard ratio remained nearly identical after adjustment for clinical and therapeutic confounders. B-type natriuretic peptide(2.75, 95% CI: 1.94- 3.89; P < 0.001), C-reactive protein(1.79, 95% CI: 1.43- 2.24; P < 0.001), and TIMP-1(1.30, 95% CI: 1.07- 1.58; P=0.008) were independently associated with future cardiovascular death. Conclusion: In patients with CAD, TIMP-1 proves as an independent predictor for future cardiovascular death.
