PDF(Pubmed)
Abstract：
UNASSIGNED: Mitral regurgitation (MR) has a high prevalence and aggravates hypoperfusion and hypoxia in heart failure (HF). Renal tubular epithelial cells are sensitive to hypoxia, and therefore tubulointerstitial damage is quite common in HF. However, the correlation between tubular dysfunction and MR has not been studied. The aim of this work was to evaluate the prognostic significance of urinary N-acetyl- β -d-glucosaminidase (uNAG), a biomarker of renal tubular damage, in patients with HF and MR.
UNASSIGNED: This was a prospective cohort study of 390 patients (mean age 64 years; 65.6% male) with uNAG measurement on admission (expressed as urinary NAG/urinary creatinine) and at least 1 year of follow-up data. The pre-defined primary endpoint was the composite of all-cause mortality or rehospitalization for HF after discharge. Cox regression analysis, restricted cubic splines, and subgroup analysis were used to investigate the prognostic value of uNAG modeled as a categorical (quartiles) or continuous (per SD increase) variable.
UNASSIGNED: A total of 153 (39.23%) patients reached the composite endpoint over a median follow-up time of 1.2 years. The uNAG level correlated with the severity of HF and with the incidence of adverse events. In a multivariable Cox regression model, each SD (13.80 U/g ⋅ Cr) of increased uNAG was associated with a 17% higher risk of death or HF rehospitalization (95% confidence interval, 2-33%, p = 0.022), and a 19% higher risk of HF rehospitalization (p = 0.027). Subgroup analysis revealed the associations between uNAG and poor prognosis were only significant in younger patients ( ≤ 65 years) and in patients without obvious cardiovascular comorbidities.
UNASSIGNED: uNAG levels at admission were associated with the risk of adverse outcomes in patients with HF and MR. Additional studies are needed to further investigate the heart-kidney interaction.
UNASSIGNED: This was a prospective cohort study of 390 patients (mean age 64 years; 65.6% male) with uNAG measurement on admission (expressed as urinary NAG/urinary creatinine) and at least 1 year of follow-up data. The pre-defined primary endpoint was the composite of all-cause mortality or rehospitalization for HF after discharge. Cox regression analysis, restricted cubic splines, and subgroup analysis were used to investigate the prognostic value of uNAG modeled as a categorical (quartiles) or continuous (per SD increase) variable.
UNASSIGNED: A total of 153 (39.23%) patients reached the composite endpoint over a median follow-up time of 1.2 years. The uNAG level correlated with the severity of HF and with the incidence of adverse events. In a multivariable Cox regression model, each SD (13.80 U/g ⋅ Cr) of increased uNAG was associated with a 17% higher risk of death or HF rehospitalization (95% confidence interval, 2-33%, p = 0.022), and a 19% higher risk of HF rehospitalization (p = 0.027). Subgroup analysis revealed the associations between uNAG and poor prognosis were only significant in younger patients ( ≤ 65 years) and in patients without obvious cardiovascular comorbidities.
UNASSIGNED: uNAG levels at admission were associated with the risk of adverse outcomes in patients with HF and MR. Additional studies are needed to further investigate the heart-kidney interaction.
摘要：
■二尖瓣反流（MR）的患病率很高，并且会加剧心力衰竭（HF）的灌注不足和缺氧。肾小管上皮细胞对缺氧敏感,因此肾小管间质损伤在HF中相当常见。然而,尚未研究肾小管功能障碍与MR之间的相关性。这项工作的目的是评估尿N-乙酰-β-d-氨基葡萄糖苷酶（uNAG）的预后意义，肾小管损伤的生物标志物，在HF和MR患者中。
■这是一项前瞻性队列研究，包括390名患者（平均年龄64岁；65.6％为男性），入院时进行uNAG测量（以尿NAG/尿肌酐表示）和至少1年的随访数据。预定义的主要终点是全因死亡率或出院后因HF再住院的复合终点。Cox回归分析，受限三次样条,和亚组分析用于研究以分类(四分位数)或连续(每SD增加)变量建模的uNAG的预后价值。
■共有153名（39.23%）患者在1.2年的中位随访时间内达到了复合终点。uNAG水平与HF的严重程度和不良事件的发生率相关。在多变量Cox回归模型中，uNAG增加的每个SD（13.80U/g·Cr）与死亡或HF再住院风险增加17％相关（95％置信区间，2-33%,p=0.022),心力衰竭再住院的风险增加19%(p=0.027)。亚组分析显示，uNAG与不良预后之间的关联仅在年轻患者（≤65岁）和无明显心血管合并症的患者中有统计学意义。
■uNAG水平与HF和MR患者的不良结局风险相关。需要更多的研究来进一步研究心-肾的相互作用。
■这是一项前瞻性队列研究，包括390名患者（平均年龄64岁；65.6％为男性），入院时进行uNAG测量（以尿NAG/尿肌酐表示）和至少1年的随访数据。预定义的主要终点是全因死亡率或出院后因HF再住院的复合终点。Cox回归分析，受限三次样条,和亚组分析用于研究以分类(四分位数)或连续(每SD增加)变量建模的uNAG的预后价值。
■共有153名（39.23%）患者在1.2年的中位随访时间内达到了复合终点。uNAG水平与HF的严重程度和不良事件的发生率相关。在多变量Cox回归模型中，uNAG增加的每个SD（13.80U/g·Cr）与死亡或HF再住院风险增加17％相关（95％置信区间，2-33%,p=0.022),心力衰竭再住院的风险增加19%(p=0.027)。亚组分析显示，uNAG与不良预后之间的关联仅在年轻患者（≤65岁）和无明显心血管合并症的患者中有统计学意义。
■uNAG水平与HF和MR患者的不良结局风险相关。需要更多的研究来进一步研究心-肾的相互作用。
