Heart:无心衰的房颤患者利钠肽水平的预后意义

2020-11-24 MedSci原创 MedSci原创

NT-proBNP水平是无HF房颤患者不良预后的重要标志,可能具有重要的临床价值。

利钠肽是心力衰竭(HF)患者重要的预后标志物,但其在无心衰的房颤(AF)患者中的预后意义知之甚少,而这些患者的利钠肽水平在日常临床实践中并未得到充分利用。

近日,心脏病领域权威杂志Heart上发表了一篇研究文章,该研究是一项对日本京都伏见区AF患者进行的社区前瞻性调查研究。研究人员使用B型利钠肽(BNP,n=388)或B型利钠肽前体N末端(NT-proBNP,n=771)的数据调查了无HF(HF定义为既往有HF住院,纽约心功能分级≥2或左心室射血分数<40%)的AF患者。研究人员使用转换公式将BNP转换为NT-proBNP,并根据NT-proBNP水平的四分位数对患者进行分类,且比较了背景和结局。

1159例患者(平均年龄为72.1±10.2岁,CHA2DS2-VASc评分中位数为3,口服抗凝剂(OAC)处方:671人(56%)),NT-proBNP中位数为488(IQR为169-1015)ng/L,NT-proBNP水平较高的患者年龄较大,CHA2DS2-VASc评分较高,并且OAC处方较多(所有p<0.001)。Kaplan-Meier曲线表明,在5.0年的中位随访期内,NT-proBNP水平与卒中/全身性栓塞、全因死亡和心衰住院的发生率较高显著相关(对数秩检验,所有p<0.001)。多变量Cox回归分析显示,即使在各种混杂因素调整后,NT-proBNP水平仍是不良结局的独立预测因子。

由此可见,NT-proBNP水平是无HF房颤患者不良预后的重要标志,可能具有重要的临床价值。

原始出处:

Yasuhiro Hamatani.et al.Prognostic significance of natriuretic peptide levels in atrial fibrillation without heart failure.heart.2020.https://heart.bmj.com/content/early/2020/11/19/heartjnl-2020-317735

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time=2020-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031321, encodeId=6e8d1031321bc, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Tue Nov 24 22:41:36 CST 2020, time=2020-11-24, status=1, ipAttribution=)]
    2020-12-17 金铃369

    学习了

    0

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time=2020-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031321, encodeId=6e8d1031321bc, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Tue Nov 24 22:41:36 CST 2020, time=2020-11-24, status=1, ipAttribution=)]
    2020-11-25 Sunny orchard

    NT-proBNP水平是无HF#房颤#患者不良预后的重要标志。检测房颤患者BNP水平可以预测疾病预后。

    1

    展开1条回复
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time=2020-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031321, encodeId=6e8d1031321bc, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Tue Nov 24 22:41:36 CST 2020, time=2020-11-24, status=1, ipAttribution=)]
    2020-12-10 Jassion

    学到了

    0

  4. 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time=2020-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031321, encodeId=6e8d1031321bc, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Tue Nov 24 22:41:36 CST 2020, time=2020-11-24, status=1, ipAttribution=)]
    2020-11-27 咻凡

    NT-proBNP水平是无HF房颤患者不良预后的重要标志,可能具有重要的临床价值。

    0

  5. 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time=2020-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031321, encodeId=6e8d1031321bc, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Tue Nov 24 22:41:36 CST 2020, time=2020-11-24, status=1, ipAttribution=)]
    2020-11-26 zhaojie88
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  8. 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time=2020-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031321, encodeId=6e8d1031321bc, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Tue Nov 24 22:41:36 CST 2020, time=2020-11-24, status=1, ipAttribution=)]
    2020-11-26 slcumt
  9. 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  10. 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time=2020-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031321, encodeId=6e8d1031321bc, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Tue Nov 24 22:41:36 CST 2020, time=2020-11-24, status=1, ipAttribution=)]
    2020-11-24 心介

    房颤,临床上碰到很多哦

    0

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NEJM:老年房颤患者低剂量依度沙班的疗效分析

在非瓣膜性心房颤动老年患者中,它们不适合作为标准剂量的口服抗凝药,在预防卒中或全身性栓塞方面,每天一次15 mg的依度沙班优于安慰剂,且未导致严重出血发病率明显升高。

明晰现状,探寻我国房颤患者抗凝治疗改善的方向和策略

全国房颤预防栓塞事件的一个重要策略就是规范抗凝治疗。我们全社会要高度关注近千万房颤人群及其中会发生栓塞事件的近60万人群(每年),要高度关注房颤规范化抗凝的科学管理,包括药物选择。