在患有心房的患者中使用生物标志物的心力衰竭风险评估:来自COMBINE-AF的分析
Paul M Haller1, Petr Jarolim2, Michael G Palazzolo3
1TIMI Study Group, Division of Cardiovascular Medicine, Brigham & Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA; Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany. Electronic address: https://twitter.com/PaulMHaller.
Journal of the American College of Cardiology
|September 4, 2024
概括
生物标志物包括N终端亲B型尿素 (NT-proBNP) 和高灵敏性心脏素T (hs-cTnT) 显著改善心脏衰竭 (HF) 风险预测心房动 (AF) 患者. 这些标志物有助于识别高风险个体,以便更好地管理.
科学领域:
- 心脏病学 心脏病学
- 生物标志物研究 生物标志物研究
- 在心房的管理管理.
背景情况:
- 心力衰竭 (HF) 是心房动 (AF) 患者的显著并发症.
- 准确的风险分层对AF患者的HF在临床决策至关重要.
- 现有的风险模型可能无法完全捕捉该人群中HF发展或进展的风险.
研究的目的:
- 评估NT-proBNP,hs-cTnT和GDF-15对于AF患者中HF风险分层的增量预后值.
- 确定这些生物标志物对预测HF住院或心血管死亡的独立贡献.
- 为了比较这些生物标志物的表现,识别患有高风险HF事件的患者.
主要方法:
- 在COMBINE-AF队列中,从三个主要随机试验 (ARISTOTLE,ENGAGE AF-TIMI 48,RE-LY) 中汇集了个体患者数据.
- 包括32,041名具有可用的基线生物标志物数据的患者.
- 使用经过临床因素调整的考克斯回归和加权定量总回归进行分析,以评估生物标志物对复合终点 (HF住院/心血管死亡) 和二次终点 (HF住院,HF相关死亡) 的贡献.
主要成果:
- 高水平的NT-proBNP,hs-cTnT和GDF-15与心血管死亡/心血管住院,心血管住院和心血管相关死亡风险的分级增加有关.
- 所有三个生物标志物 (NT-proBNP,hs-cTnT,GDF-15) 在调整临床变量和其他生物标志物后,独立预测了心血管死亡/HF住院.
- 添加生物标志物显著改善了临床风险模型的歧视 (c指数从0.70增加到0.77).
- NT-proBNP和hs-cTnT对评估心血管死亡/心血管疾病住院的风险作出了相似而实质性的贡献 (38%和41%),而GDF-15对心血管死亡/心血管疾病住院的风险作出了较小但重要的贡献.
结论:
- NT-proBNP,hs-cTnT和GDF-15是AF患者中HF结局的显著和独立预测因素.
- hs-cTnT与NT-proBNP同样重要,在这个患者群体内分层化HF风险.
- 这些生物标志物可能在临床实践中被用于识别低或高风险的AF患者,以指导进一步的治疗策略.
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