发布日期：2007 年 8 月
英文标题：Prognostic importance of plasma NT-pro BNP in chronic heart failure in patients treated with a beta-blocker: results from the Carvedilol Or Metoprolol European Trial (COMET) trial.
作者：Olsson LG, Swedberg K, Cleland JG, Spark PA, Komajda M, Metra M, Torp-Pedersen C, Remme WJ, Scherhag A, Poole-Wilson P; COMET Investigators.
出处：Eur J Heart Fail. 2007 Aug;9(8):795-801.
内容介绍：纳入 3029 例 EF＜35% 伴心功能 NYHA II-IV 级的 CHF 患者，随机接受卡维地洛或酒石酸美托洛尔，平均随访 58 个月。 分别在基线和随访时测定 NT-pro BNP 水平，并观察对患者预后的影响。结果显示，NT-proBNP 水平升高与患者预后不佳相关；基线 NT-proBNP 升高，患者生存率显著降低；随访期间 NT-proBNP 持续高水平，患者生存率降低。
摘要展示：
BACKGROUND:
Plasma levels of N-terminal pro-brain natriuretic peptide (NT-pro BNP) are increased in patients with chronic heart failure (CHF). Beta-blockers (BB) may influence these levels but it is unclear whether changes in NT-pro BNP reflect concomitant changes in prognosis.
OBJECTIVES:
To assess the prognostic importance of NT-pro BNP at baseline and during follow-up, in patients in whom beta-blocker therapy is initiated.
METHODS:
In COMET, 3029 patients with CHF in NYHA class II-IV and EF<35% were randomised to carvedilol or metoprolol tartrate and were followed for an average of 58 months. Blood samples were collected for the measurement of NT-pro BNP at baseline (n = 1559) and during follow-up (n = 309).
RESULTS:
Baseline plasma concentrations of NT-pro BNP above the median (1242 pg/ml) were associated with higher all-cause mortality (RR 2.77; 95% CI 2.33-3.3, p<0.001). Patients who achieved NT-pro BNP levels<400 pg/ml during follow-up had a lower subsequent mortality (RR 0.32; 95% CI 0.15-0.69, p = 0.004).
CONCLUSIONS:
The plasma concentration of NT-pro BNP is a powerful predictor of mortality in patients with CHF. Patients who achieve an NT-pro BNP of <400 pg/ml subsequent to treatment with a beta-blocker have a favourable prognosis.
