Prognostic Value and Kinetics of Soluble Neprilysin in Acute Heart Failure A Pilot Study
Por:
Bayes-Genis, A, Barallat, J, Pascual-Figal, D, Nunez, J, Minana, G, Sanchez-Mas, J, Galan, A, Sanchis, J, Zamora, E, Perez-Martinez, MT and Lupon, J
Publicada:
1 ago 2015
Categoría:
Cardiology and cardiovascular medicine
Resumen:
OBJECTIVES This study sought to examine the prognostic value of the soluble form of neprilysin (sNEP) in acute heart failure (AHF) and sNEP kinetics during hospital admission.
BACKGROUND sNEP was recently identified in chronic heart failure (HF) and was associated with cardiovascular outcomes.
METHODS A total of 350 patients (53% women, mean 72.6 +/- 10.7 years of age) were included in the study. Primary endpoints were composites of cardiovascular death or HF hospitalizations at short-term (2 months) and long-term (mean: 1.8 +/- 1.2 years) follow-up. sNEP was measured using an ad hoc-modified enzyme-linked immunosorbent assay, and its prognostic value was assessed using Cox regression analyses. In a subgroup of patients, sNEP was measured both at admission and at discharge (n = 92).
RESULTS Median admission sNEP concentrations were 0.67 ng/ml (Q1 to Q3: 0.37 to 1.29), and sNEP was significantly associated, in age-adjusted Cox regression analyses, with the composite endpoint at short-term (hazard ratio [HR]: 1.29; 95% confidence interval [CI]: 1.04 to 1.61; p = 0.02) and long-term (HR: 1.23; 95% CI: 1.01 to 1.05; p = 0.003) follow-up. In multivariate Cox analyses that included clinical variables and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration, sNEP concentration at admission showed a clear trend toward significance for the composite endpoint at 2 months (HR: 1.22; 95% CI: 0.97 to 1.53; p = 0.09) and remained significant at the end of followup (HR: 1.21; 95% CI: 1.04 to 1.40; p = 0.01). At discharge, sNEP levels decreased from 0.70 to 0.52 ng/ml (p = 0.06).
CONCLUSIONS Admission sNEP concentration was associated with short-and long-term outcomes in AHF, and dynamic sNEP concentrations were observed during hospital admission. These preliminary data may be hypothesisgenerating for the use of NEP inhibitors in AHF. (C) 2015 by the American College of Cardiology Foundation.
Filiaciones:
:
Hosp Badalona Germans Trias & Pujol, Serv Cardiol, Badalona 08916, Spain
Hosp Badalona Germans Trias & Pujol, Heart Failure Unit, Badalona 08916, Spain
Autonomous Univ Barcelona, Dept Med, Barcelona, Spain
Barallat, J:
Hosp Badalona Germans Trias & Pujol, Biochem Serv, Badalona 08916, Spain
Pascual-Figal, D:
Univ Murcia, Dept Cardiol, Hosp Virgen de la Arrixaca, Dept Med, Murcia, Spain
Nunez, J:
Hosp Clin Univ, Biochem Serv, Valencia, Spain
Univ Valencia, Valencia, Spain
Minana, G:
Hosp Clin Univ, Serv Cardiol, Valencia, Spain
Sanchez-Mas, J:
Univ Murcia, Dept Cardiol, Hosp Virgen de la Arrixaca, Dept Med, Murcia, Spain
Galan, A:
Hosp Badalona Germans Trias & Pujol, Biochem Serv, Badalona 08916, Spain
Sanchis, J:
Hosp Manises, Serv Cardiol, Valencia, Spain
:
Hosp Badalona Germans Trias & Pujol, Serv Cardiol, Badalona 08916, Spain
Hosp Badalona Germans Trias & Pujol, Heart Failure Unit, Badalona 08916, Spain
Autonomous Univ Barcelona, Dept Med, Barcelona, Spain
Perez-Martinez, MT:
Univ Murcia, Dept Cardiol, Hosp Virgen de la Arrixaca, Dept Med, Murcia, Spain
:
Hosp Badalona Germans Trias & Pujol, Serv Cardiol, Badalona 08916, Spain
Hosp Badalona Germans Trias & Pujol, Heart Failure Unit, Badalona 08916, Spain
Autonomous Univ Barcelona, Dept Med, Barcelona, Spain
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