JACC:NT-proBNP和 “新四联”恩格列净在心衰预后中的作用

2021-09-23 MedSci原创 MedSci原创

较高的基线NT-proBNP浓度与较大的心力衰竭或肾脏不良结局风险有关,但无论基线NT-proBNP浓度如何,恩格列净都会降低上述风险。

在射血分数降低的心力衰竭(HFrEF)患者中,NT-proBNP浓度升高与更严重的症状、更差的健康状况以及因HF住院或血管(CV)死亡的更高风险有关。在HFrEF患者中,NT-proBNP浓度升高或上升与更多的失代偿血流动力学特征、更高的充盈压和更大的进行性不良心脏重塑、住院和死亡风险有关。

相反,在HFrEF治疗后,NT-proBNP值的降低预示着结果的改善,更好的健康状况,以及更多的有利反向心脏重塑的可能性。大多数降低HFrEF死亡率或住院率的治疗方法会使NT-proBNP的浓度有所下降。

然而,目前还没有报道恩格列净对HFrEF的益处及与NT-proBNP之间的关系。为了全面评估NT-proBNP与恩格列净在EMPEROR-Reduced试验中的关系,来自美国麻省总院心血管专家开展了相关研究,结果发表在近期JACC杂志上。

HFrEF患者被随机分配到安慰剂或恩格列净每天10毫克。在基线、4周、12周、52周和100周测量NT-proBNP。患者根据基线NT-proBNP的四分位数进行分组。

结果显示,与NT-proBNP最低四分位数相比,最高四分位数(≥3480 vs <1115 pg/mL)的患者每个CVD结果的发生率都高出4-6倍。同时NT-proBNP较高的研究参与者的总住院次数比NT-proBNP最低的四分位数高2-3倍。

试验结果与基线和随访的NT-proBNP浓度的关系

另一方面,恩格列净降低了主要心肾事件的风险,在NT-proBNP四分位数之间没有异质性。恩格列净治疗在所有随访时间点都能显著降低NT-proBNP;到52周时,与安慰剂相比,恩格列净治疗使NT-proBNP平均降低13%。

此外,无论基线水平如何,随访12周后,NT-proBNP处于最低四分位数(<1115 pg/mL),与随后的心血管死亡或心衰住院的风险较低有关。与安慰剂相比,使用恩格列净治疗12周后,NT-proBNP浓度<1115 pg/mL的比例增加27%。

EMPEROR-Reduced试验主要的研究发现

综上,较高的基线NT-proBNP浓度与较大的心力衰竭或肾脏不良结局风险有关,但无论基线NT-proBNP浓度如何,恩格列净都会降低上述风险。

 

参考文献:

Prognostic Importance of NT-proBNP and Effect of Empagliflozin in the EMPEROR-Reduced Trial. J Am Coll Cardiol. 2021 Sep, 78 (13) 1321–1332

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    2021-10-09 hbwxf
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    2021-10-19 H8888888

    不错

    0

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    2021-09-25 huiwelcome
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    2021-09-25 mjldent
  5. [GetPortalCommentsPageByObjectIdResponse(id=1854990, encodeId=401b1854990fc, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Sat Oct 09 17:47:49 CST 2021, time=2021-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1061877, encodeId=592310618e7d6, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=989a5607928, createdName=H8888888, createdTime=Tue Oct 19 16:33:39 CST 2021, time=2021-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1289345, encodeId=f4b2128934531, content=<a href='/topic/show?id=ede136018b' target=_blank style='color:#2F92EE;'>#BNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3601, encryptionId=ede136018b, topicName=BNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd0d217, createdName=huiwelcome, createdTime=Sat Sep 25 04:47:49 CST 2021, time=2021-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290367, encodeId=dee6129036e25, content=<a href='/topic/show?id=f6e513111bc' target=_blank style='color:#2F92EE;'>#NT-proBNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13111, encryptionId=f6e513111bc, topicName=NT-proBNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5662228, createdName=mjldent, createdTime=Sat Sep 25 04:47:49 CST 2021, time=2021-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326860, encodeId=9ff4132686073, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Sat Sep 25 04:47:49 CST 2021, time=2021-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1602385, encodeId=9d8116023859c, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14697, encryptionId=2f801469e57, topicName=PRO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a60b18898917, createdName=sunylz, createdTime=Sat Sep 25 04:47:49 CST 2021, time=2021-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1054193, encodeId=e36a1054193aa, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=16705611430, createdName=ms5000000315862721, createdTime=Thu Sep 23 16:43:44 CST 2021, time=2021-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1054164, encodeId=5ae5105416430, content=很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=107e5614367, createdName=ms1000001149010553, createdTime=Thu Sep 23 15:14:43 CST 2021, time=2021-09-23, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1854990, encodeId=401b1854990fc, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Sat Oct 09 17:47:49 CST 2021, time=2021-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1061877, encodeId=592310618e7d6, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=989a5607928, createdName=H8888888, createdTime=Tue Oct 19 16:33:39 CST 2021, time=2021-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1289345, encodeId=f4b2128934531, content=<a href='/topic/show?id=ede136018b' target=_blank style='color:#2F92EE;'>#BNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3601, encryptionId=ede136018b, topicName=BNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd0d217, createdName=huiwelcome, createdTime=Sat Sep 25 04:47:49 CST 2021, time=2021-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290367, encodeId=dee6129036e25, content=<a href='/topic/show?id=f6e513111bc' target=_blank style='color:#2F92EE;'>#NT-proBNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13111, encryptionId=f6e513111bc, topicName=NT-proBNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5662228, createdName=mjldent, createdTime=Sat Sep 25 04:47:49 CST 2021, time=2021-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326860, encodeId=9ff4132686073, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Sat Sep 25 04:47:49 CST 2021, time=2021-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1602385, encodeId=9d8116023859c, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14697, encryptionId=2f801469e57, topicName=PRO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a60b18898917, createdName=sunylz, createdTime=Sat Sep 25 04:47:49 CST 2021, time=2021-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1054193, encodeId=e36a1054193aa, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=16705611430, createdName=ms5000000315862721, createdTime=Thu Sep 23 16:43:44 CST 2021, time=2021-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1054164, encodeId=5ae5105416430, content=很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=107e5614367, createdName=ms1000001149010553, createdTime=Thu Sep 23 15:14:43 CST 2021, time=2021-09-23, status=1, ipAttribution=)]
    2021-09-25 sunylz
  7. [GetPortalCommentsPageByObjectIdResponse(id=1854990, encodeId=401b1854990fc, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Sat Oct 09 17:47:49 CST 2021, time=2021-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1061877, encodeId=592310618e7d6, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=989a5607928, createdName=H8888888, createdTime=Tue Oct 19 16:33:39 CST 2021, time=2021-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1289345, encodeId=f4b2128934531, content=<a href='/topic/show?id=ede136018b' target=_blank style='color:#2F92EE;'>#BNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3601, encryptionId=ede136018b, topicName=BNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd0d217, createdName=huiwelcome, createdTime=Sat Sep 25 04:47:49 CST 2021, time=2021-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290367, encodeId=dee6129036e25, content=<a href='/topic/show?id=f6e513111bc' target=_blank style='color:#2F92EE;'>#NT-proBNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13111, encryptionId=f6e513111bc, topicName=NT-proBNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5662228, createdName=mjldent, createdTime=Sat Sep 25 04:47:49 CST 2021, time=2021-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326860, encodeId=9ff4132686073, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Sat Sep 25 04:47:49 CST 2021, time=2021-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1602385, encodeId=9d8116023859c, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14697, encryptionId=2f801469e57, topicName=PRO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a60b18898917, createdName=sunylz, createdTime=Sat Sep 25 04:47:49 CST 2021, time=2021-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1054193, encodeId=e36a1054193aa, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=16705611430, createdName=ms5000000315862721, createdTime=Thu Sep 23 16:43:44 CST 2021, time=2021-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1054164, encodeId=5ae5105416430, content=很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=107e5614367, createdName=ms1000001149010553, createdTime=Thu Sep 23 15:14:43 CST 2021, time=2021-09-23, status=1, ipAttribution=)]
    2021-09-23 ms5000000315862721

    学习了

    0

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    2021-09-23 ms1000001149010553

    很好

    0

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J Cardiothorac Surg:NT-proBNP与经导管主动脉瓣置换术后的临床结果相关

关于经导管主动脉瓣置换(TAVR)后血浆N-末端前B型利钠肽(NT-proBNP)围手术期变化的预后价值,有限的数据。

一表详解,BNP 与 NT-proBNP 的区别

利钠肽大家族中的脑钠肽(BNP)和 N 末端 B 型利钠肽原(NT-proBNP)是目前最重要的心脏功能生物标志物。我们今天讨论的重点就是 NT-proBNP,一起看下它在心衰诊断中的地位。

JAHA:NT-proBNP与成人全因死亡率和心血管死亡率的关系

在美国成人代表性样本中NT-proBNP是全因和CVD死亡率的重要独立危险因素。NT-proBNP可能对一般人群的风险监测有用。

Circ Heart Fail:PARADISE-MI 试验中高危心肌梗死后 NT-proBNP的预后重要性

在高危MI的第一周内,NT-proBNP与发生HF、死亡和动脉硬化事件有关。这一预后信息与hs-cTnT无关。

Circulation:根据NT-proBNP进行系统性房颤筛查的效果分析

在有额外卒中危险因素的老年人群中,ILR筛查房颤与NT-proBNP水平较高的个体卒中风险显著降低相关,但与NT-proBNP水平较低的个体无关。