实时三维超声心动图联合血清NT-proBNP、MR-proADM、sST2对心力衰竭患者诊断及预后的评估价值

摘要 目的：探讨实时三维超声心动图（RT-3DE）联合血清N末端脑钠肽前体（NT-proBNP）、肾上腺髓质素前体中段肽（MR-proADM）、可溶性人基质裂解素2（sST2）对心力衰竭（HF）患者诊断及预后的评估价值。方法：选择2020年3月至2022年10月阳光融和医院收治的112例HF患者（HF组）,另选择同期体检健康的50例志愿者（对照组）。所有受试者均接受RT-3DE检查,同时检测血清NT-proBNP、MR-proADM、sST2水平。对比两组RT-3DE参数和血清NT-proBNP、MR-proADM、sST2水平。HF患者出院后随访6个月,统计患者预后情况;根据预后将患者分为预后不良组（37例）和预后良好组（75例）。受试者工作特征（ROC）曲线分析RT-3DE参数联合血清NT-proBNP、MR-proADM、sST2诊断HF的临床价值及对预后不良的预测价值。结果：HF组左室收缩末期容积（LVESV）、左室舒张末期容积（LVEDV）、左室舒张末期容积指数（LVEDVI）、收缩末期容积指数（LVESVI）、血清NT-proBNP、MR-proADM、sST2水平高于对照组（P＜0.05）,左室射血分数（LVEF）低于对照组（P＜0.05）。RT-3DE参数联合血清NT-proBNP、MR-proADM、sST2诊断HF的曲线下面积（AUC）为0.902,高于各指标单独诊断。预后不良组LVESV、LVEDV、LVEDVI、LVESVI、血清NT-proBNP、MR-proADM、sST2水平高于预后良好组（P＜0.05）,LVEF低于预后良好组（P＜0.05）。RT-3DE参数联合NT-proBNP、MR-proADM、sST2预测HF预后不良的AUC为0.937,高于各指标单独预测。结论：HF患者LVESV、LVEDV、LVEDVI、LVESVI、血清NT-proBNP、MR-proADM、sST2水平增高,LVEF降低,联合RT-3DE参数和血清NT-proBNP、MR-proADM、sST2可提高对HF诊断和预后预测的效能。     

急性心力衰竭患者血清Adropin、sST2、Gal-3水平与预后的关系分析

目的:探讨急性心力衰竭患者血清Adropin、可溶性ST2受体(s ST2)、半乳糖凝集素-3(Gal-3)水平与预后的关系。方法:选取2015年6月～2019年6月期间内蒙古自治区人民医院收治的154例急性心力衰竭患者纳入心衰组,另选同期在内蒙古自治区人民医院进行健康体检的100例志愿者为对照组。对比心衰组、对照组血清Adropin、s ST2、Gal-3水平,并将心衰组患者按美国纽约心脏病协会(NYHA)心功能分级分为II级组(n=38)、III级组(n=64)、IV级组(n=52),对比三组患者的血清Adropin、s ST2、Gal-3水平。心衰组患者经治疗出院后,根据患者的预后效果分为预后良好组(n=95)和预后不良组(n=59),采用单因素和Logistic多元回归分析急性心力衰竭患者预后不良的影响因素。结果:心衰组血清Adropin、s ST2、Gal-3水平均高于对照组(P0.05)。心衰组患者中随着心功能分级的升高,患者的血清Adropin、s ST2、Gal-3水平均显著升高(P0.05)。预后不良患者59例,发生率为38.31%。单因素分析结果显示,预后不良组和预后良好组患者在年龄、性别、体质指数(BMI)、吸烟史、饮酒史、基础疾病、血常规指标的比较无统计学差异(P0.05)。预后不良组患者的心功能分级、血清Adropin、s ST2、Gal-3水平均高于预后良好组(P0.05)。Logistic多元回归分析显示,心功能分级为IV级、Adropin≥10ng/mL、s ST2≥150μg/m L、Gal-3≥5μg/L是急性心力衰竭患者预后不良的危险因素(P0.05)。结论:急性心力衰竭患者血清Adropin、s ST2、Gal-3水平显著升高,并随患者的病情加重而升高,血清Adropin、s ST2、Gal-3水平的变化会影响患者的预后。     

血清Trx1、FGL2与急性心肌梗死后心力衰竭患者预后的关系

摘要 目的：探讨血清硫氧还蛋白1（Trx1）、纤维蛋白原样蛋白2（FGL2）与急性心肌梗死后心力衰竭患者预后的关系。方法：选择2019年10月至2020年5月我院收治的158例急性心肌梗死后心力衰竭患者作为观察组,并根据心功能Killip分级分为Ⅱ级组54例、Ⅲ级组57例、Ⅳ级组47例。另选择同期我院收治的102例急性心肌梗死患者作为对照组。入院后采用酶联免疫吸附法（ELISA）检测所有患者血清Trx1、FGL2水平;观察组患者出院后随访2年,并根据是否出现主要不良心血管事件（MACE）将患者分为预后不良组和预后良好组。采用多因素Logistic回归分析影响急性心肌梗死后心力衰竭患者预后的相关因素,采用受试者工作特征（ROC）曲线评估血清Trx1、FGL2对急性心肌梗死后心力衰竭患者预后的预测价值。结果：观察组血清FGL2水平明显高于对照组,血清Trx1水平明显低于对照组（P<0.05）;心功能Killip分级Ⅳ级组患者血清Trx1水平明显低于Ⅱ级组、Ⅲ级组（P<0.05）,血清FGL2水平明显高于Ⅱ级组、Ⅲ级组（P<0.05）。预后不良组患者血清Trx1、LVEF均明显低于预后良好组,而年龄、血清FGL2及血尿酸、血肌酐、N末端B型利钠肽原（NT-proBNP）均明显高于预后良好组（P<0.05）,两组心功能Killip分级比例比较差异有统计学意义（P<0.05）。多因素Logistic回归分析显示,年龄（较高）、心功能Killip分级为Ⅳ级、Trx1下降、FGL2升高均是影响急性心肌梗死后心力衰竭患者预后的危险因素（P<0.05）。ROC曲线结果显示,血清Trx1、FGL2预测急性心肌梗死后心力衰竭患者预后的曲线下面积分别为0.807、0.811,两者联合检测预测急性心肌梗死后心力衰竭患者预后的曲线下面积为0.889。结论：急性心肌梗死后心力衰竭患者血清中Trx1水平降低,FGL2水平升高,且血清Trx1、FGL2水平与患者心功能分级及预后密切相关,可作为评估急性心肌梗死后心力衰竭患者预后的辅助性指标。     

慢性心力衰竭患者血清sST2、IL-6和肽素水平的变化及临床意义

目的:探讨慢性心力衰竭(CHF)患者血清可溶性人基质裂解素2(sST2)、白细胞介素-6(IL-6)、和肽素水平的变化及临床意义。方法:选取2017年1月-2018年1月期间我院收治的CHF患者122例纳入CHF组,根据纽约心脏协会(NYHA)心功能分级将患者分为II级组34例,III级组48例,IV级组40例。另选取同期住院的心律失常非CHF患者35例为对照组。检测并比较CHF组与对照组患者血清sST2、和肽素、IL-6水平,比较不同NYHA心功能分级CHF患者血清sST2、和肽素、IL-6水平,采用Pearson相关性分析血清sST2、IL-6及和肽素三指标间的相关性。结果:CHF组患者血清sST2、和肽素、IL-6水平均高于对照组,差异有统计学意义(P0.05)。不同NYHA心功能分级的CHF患者血清sST2、和肽素、IL-6水平整体比较差异均有统计学意义(P0.05),IV级组、III级组患者血清sST2、和肽素、IL-6水平均高于II级组患者,且IV级组高于III级组,差异有统计学意义(P0.05)。经Pearson相关性分析显示,血清sST2、IL-6水平与和肽素均呈正相关性(P0.05)。结论:血清sST2、和肽素、IL-6水平与CHF的严重程度密切相关,可考虑将其作为临床诊断CHF的生物学指标。     

犬细小病毒VP2基因在大肠杆菌中的高效可溶性表达

目的:犬细小病毒VP2基因在大肠杆菌中高效可溶性表达,进而为其特异单克隆抗体的制备奠定基础。方法:以犬细小病毒VP2基因重组质粒为模板,通过蛋白质分析软件PROSPECT分析,根据VP2基因所编码的氨基酸的亲水性和抗原性,把VP2基因分成不同区段,设计相应引物并扩增出相应片段。按常规方法克隆入pGEX-4T-2载体谷光甘肽-S-转移酶(GST)基因的下游,获得的重组质粒转化大肠杆菌BL21,用IPTG诱导目的基因片段的表达,经超声处理后SDS-PAGE电泳。所得可溶性蛋白再经间接ELISA、western Blotting鉴定。结果:K2和K4片段获得了良好的可溶性表达,其表达的GST融合蛋白的分子质量分别为38.3 KD和41 KD,ELISA、Western Blotting结果表明所表达的融合蛋白具有与CPV阳性抗体特异结合的良好抗原性。结论:犬细小病毒VP2基因在大肠杆菌中的获得了高效可溶性表达。     

结核分枝杆菌CysA2抗原的基因克隆、表达及在血清诊断中的应用

目的 克隆并构建结核分枝杆菌CysA2基因原核表达系统,建立基于rCysA2的ELISA并检测rCys A2-ELISA在肺结核患者血清学诊断中的敏感性和特异性.方法 采用PCR扩增CysA2基因,构建CysA2基因原核表达系统.采用SDS-PAGE检测目的重组蛋白rCysA2表达情况,Ni-NTA亲和层析法提纯rCysA2,免疫印迹鉴定rCysA2的免疫反应性.以rCysA2为包被抗原,建立rCysA2-ELISA并用于检测132例血清抗体,其中涂片阳性和阴性肺结核患者血清分别占96例和36例,非肺结核肺部疾病病人血清抗体30例,健康对照血清50例.结果 克隆的CysA2基因与GenBank中相关序列相似性为100％.rCysA2表达量为细菌总蛋白的25.4％.提纯的rCysA2在SDS-PAGE后显示为单一的蛋白条带.rCysA2-ELISA检测涂片阳性和涂片阴性的肺结核患者血清抗体检出率分别为63.5％和61.1％,50例健康对照全部阴性、30例非肺结核肺部疾病患者1例呈现阳性,此方法的灵敏度为62.9％(83/132),特异性为98.8％ (79/80).结论 本研究成功地克隆并构建了结核分枝杆菌CysA2基因及其原核表达系统.以rCysA2为包被抗原的rCysA2-ELISA方法有较高的灵敏度和很好的特异性,能有效检测涂片阴性患者血清抗体,rCysA2有望成为结核病血清诊断的有效候选抗原之一.     

BAG2在恶性肿瘤中的作用

Bcl-2相关抗凋亡基因2(Bcl-2-associated athanogene 2,BAG2)属于BAG基因家族成员,其特征是含有一种新型热休克蛋白70核苷酸交换因子结构域,即“BNB”结构域,可以通过各种机制介导细胞凋亡、肿瘤生长、神经元分化和应激反应等。BAG2通过与肿瘤微环境中的相关信号分子相互作用,从而在不同恶性肿瘤的发生发展中发挥重要作用。本文主要就BAG2的结构和功能及其在结直肠癌、胶质瘤、胃癌、T细胞急性淋巴细胞白血病、口腔癌、食管癌、肝细胞癌、肺癌、乳腺癌等恶性肿瘤中的作用和机制进行综述,并对BGA2在各种恶性肿瘤诊断和治疗中的潜力进行展望。     

脓毒症患儿血清SAA、PCT、CRP水平与预后的关系及其诊断价值分析

摘要 目的：探讨脓毒症患儿血清淀粉样蛋白A（SAA）、降钙素原（PCT）、C反应蛋白（CRP）与预后的关系,并分析三者对脓毒症的诊断价值。方法：纳入我院于2016年8月～2020年6月期间收治的脓毒症患儿60例开展回顾性研究,作为脓毒症组,选取同期于我院进行体检的健康儿童40例作为对照组,比较两组血清SAA、PCT、CRP水平。根据脓毒症患儿1个月内的生存、死亡情况,分成生存组（n=42）、死亡组（n=18）,比较两组临床资料及血清SAA、PCT、CRP水平,经COX回归模型分析脓毒症患儿死亡的危险因素。绘制受试者工作特征（ROC）曲线分析血清SAA、PCT、CRP对脓毒症的诊断价值。结果：脓毒症组血清SAA、PCT、CRP水平显著高于对照组（P＜0.05）。死亡组器官障碍数量＞2个、脓毒性休克患儿占比分别为55.56%、44.44%,显著高于生存组的19.05%、9.52%（P＜0.05）;死亡组入院后1 h内使用抗菌治疗患儿占比为38.89%,显著低于生存组的69.05%（P＜0.05）;死亡组血清SAA、PCT、CRP水平高于生存组（P＜0.05）。COX多因素分析结果显示,器官障碍数量＞2、脓毒性休克及血清SAA、PCT、CRP水平升高是脓毒症患儿死亡的危险因素（P＜0.05）,而入院后1 h内使用抗菌治疗是脓毒症患儿死亡风险的保护性因素（P＜0.05）。血清SAA、PCT、CRP单独及三者联合诊断脓毒症的曲线下面积（AUC）分别为0.808、0.780、0.761、0.912。结论：脓毒症患儿血清SAA、PCT、CRP明显升高,三者升高均为脓毒症患儿死亡的危险因素,且对脓毒症具有一定诊断价值。     

心脏彩超检查联合血清BNP、ALB、CysC在慢性心力衰竭患者预后评估中的临床价值分析

摘要 目的：分析心脏彩超检查联合血清B型钠尿肽（BNP）、白蛋白（ALB）、胱抑素C（CysC）在慢性心力衰竭（CHF）患者预后评估中的临床价值。方法：选取2017年6月-2018年5月我院收治的123例CHF患者,心脏彩超检查左心室射血分数（LVEF）、左心房内径（LAD）和左心室内径（LVD）,实验室检测血清BNP、ALB、CysC水平。按照3年随访后患者是否死亡分为死亡组35例和存活组88例,收集临床资料,采用多因素Logistic回归分析CHF患者预后的影响因素。采用受试者工作特征（ROC）曲线分析心脏彩超检查联合血清BNP、ALB、CysC对CHF患者预后的评估价值。结果：死亡组患者的LAD、LVD及血清BNP、CysC水平高于存活组患者,而LVEF及血清ALB水平低于存活组患者（P＜0.05）。心脏彩超指标LVEF、LAD、LVD及血清BNP、ALB、CysC是CHF患者预后的影响因素（P＜0.05）。心脏彩超指标LVEF、LAD、LVD联合血清BNP、ALB、CysC检测对CHF患者预后评估的ROC曲线下面积（AUC）（0.95CI）为0.857（0.771～0.938）,灵敏度及特异度分别为0.914（32/35）、0.795（70/88）,均明显高于上述各指标单独检测。结论：心脏彩超指标LVEF、LAD、LVD和血清BNP、ALB、CysC均为CHF患者预后的影响因素,且联合检测对患者预后的评估价值较高,具有一定的临床应用价值。     

地高辛联合左西孟旦治疗扩张型心肌病的疗效及对血清HMGB1、sICAM-1、sST2水平的影响

目的:探讨地高辛联合左西孟旦治疗扩张型心肌病的疗效及对血清高迁移率族蛋白B1(HMGB1)、溶性细胞间粘附分子-1(s ICAM-1)、可溶性ST2蛋白(s ST2)水平的影响。方法：选择2016年2月至2018年2月我院接诊的90例扩张型心肌病患者作为本研究对象,依照随机数表法分为观察组44例和对照组46例,对照组在常规治疗基础上给予左西孟旦治疗,观察组在对照组基础上联合地高辛治疗,两组均连续治疗4周。比较两组的临床疗效、左室射血分数(LVEF)、左室舒张末内径(LVEDD)、血清氨基末端B型钠尿肽前体(NT-proBNP)、HMGB1、s ICAM-1、s ST2水平的变化及不良反应的发生情况。结果:治疗后,观察组临床疗效总有效率为93.18%(41/44),明显高于对照组(76.09%,P0.05);观察组LVEF明显高于对照组,LVEDD、血清NT-proBNP水平均明显低于对照组[(46.50±5.21)%vs.(41.20±4.12)%,(54.94±2.29)mm vs.(59.30±2.38)mm,(494.31±75.95)ng/L vs.(589.56±89.40)ng/L](P0.05);观察组血清HMGB1、s ICAM-1、s ST2水平均明显低于对照组低[(8.42±1.23)pg/mL vs.(13.76±1.70)pg/mL,(122.93±11.03)μg/L vs.(141.58±13.04)μg/L,(0.08±0.02)ng/mL vs.(0.15±0.03)ng/mL](P0.05)。治疗期间,两组不良反应发生率分别为9.09%和6.52%,组间差异无统计学意义(P0.05)。结论:地高辛联合左西孟旦治疗扩张型心肌病患者的效果显著优于单用左西孟旦治疗,其可更有效降低患者血清HMGB1、s ICAM-1、s ST2的表达,改善患者心功能,且安全性高。     

Predictive values of sST2 and IL-33 for heart failure in patients with acute myocardial infarction

Timely prediction of the risk of heart failure in acute myocardial infarction patients is critical for better prognosis. This article aims to evaluate the predictive value of serum soluble growth stimulation expressed gene 2 (sST2) and interleukin-33 in patients with acute myocardial infarction complicated by heart failure. A total of 42 healthy controls and 144 acute myocardial infarction patients were recruited in the study. According to Killip cardiac function classification as the basis for concurrent heart failure, they were distributed into non-heart failure group (n = 76) and heart failure group (n = 68). ELISA was utilized to determine the serum sST2 and interleukin-33 levels, and the diagnostic efficiency was evaluated by receiver operating characteristics curve. sST2 and interleukin-33 levels in patients with acute myocardial infarction were significantly increased when compared with normal healthy controls, and were further enhanced in the heart failure group. With the increased Killip cardiac function classification, interleukin-33 and sST2 levels were gradually elevated. Multivariate analysis indicated that interleukin-33 and sST2 could be used as independent predictors for heart failure combined with acute myocardial infarction.     

The real-life value of ST2 monitoring during heart failure decompensation: impact on long-term readmission and mortality

Context: Prognostic value of ST2 levels and dynamics has not been investigated in acute heart failure (AHF) using prospective real-life measurements.

Objective: The objective of this study is to investigate the prognostic value of ST2 in AHF.

Methods: ST2 levels were determined at admission (n?=?182) and discharge (n?=?85). Primary endpoint was the composite of all-cause death and HF rehospitalisation at one year.

Results: Discharge ST2 (HR 2.42 [95% CI 1.46–4], p?=?0.001) and ΔST2 (HR 2.32 [95% CI 1.21–4.57], p?=?0.01) but not admission ST2, remained independently prognostic for the primary endpoint after comprehensive multivariable adjustment. ST2 significantly improved prognosis stratification on top of clinical variables and NTproBNP.

Conclusions: Routine clinical use of discharge ST2 and ST2 dynamics provide independent prognostic information.     

Autophagic vacuoles in cardiomyocytes of dilated cardiomyopathy with initially decompensated heart failure predict improved prognosis

Autophagy is a process of bulk protein degradation and organelle turnover, and is a current therapeutic target in several diseases. The present study aimed to clarify the significance of myocardial autophagy of patients with dilated cardiomyopathy (DCM). Left ventricular endomyocardial biopsy was performed in 250 consecutive patients with DCM (54.9±13.9 years; male, 79%), initially presenting with decompensated heart failure (HF). The association of these findings with HF mortality or recurrence was examined. Myofilament changes, which are apparent in the degenerated cardiomyocytes of DCM, were recognized in 164 patients (66%), and autophagic vacuoles in cardiomyocytes were identified in or near the area of myofilament changes in 86 patients (34%). Morphometrically, fibrosis (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.93 to 0.99) and mitochondrial abnormality (OR, 2.24; 95% CI, 1.23 to 4.08) were independently related with autophagic vacuoles. During the follow-up period of 4.9±3.9 y, 24 patients (10%) died, including 10 (4%) who died of HF, and 67 (27%) were readmitted for HF recurrence. Multivariate analysis identified a family history of DCM (hazard ratio [HR], 2.117; 95% CI, 1.199 to 3.738), hemoglobin level (HR, 0.845; 95% CI, 0.749 to 0.953), myofilament changes (HR, 13.525; 95% CI, 5.340 to 34.255), and autophagic vacuoles (HR, 0.214; 95% CI, 0.114 to 0.400) as independent predictors of death or readmission due to HF recurrence. In conclusion, autophagic vacuoles in cardiomyocytes are associated with a better HF prognosis in patients with DCM, suggesting autophagy may play a role in the prevention of myocardial degeneration.     

Elevation of IGF-2 receptor and the possible underlying implications in end-stage heart failure patients before and after heart transplantation

Up-regulation of insulin-like growth factor 2 receptor (IGF-2R) involved in angiotensin II-induced cell apoptosis in cardiomyoblasts, and correlated with cardiomyocyte apoptosis in hypertensive rat hearts. Here, we detected IGF-2R levels and explored the possible underlying implications in end-stage heart failure (HF) patients before and after heart transplantation. Western blot and immunohistochemistry were used to measure cardiac IGF-2R levels. ELISA was used to detect serum IGF-2R and CD8 levels. Labelling of DNA strand breaks and dihydroethidium detection were used to determine cellular apoptosis and reactive oxygen species, respectively. Cardiac IGF-2R levels increased in end-stage HF patients (n = 11) compared with non-failing control subjects. Leu27-IGF-2, an IGF-2 analogue to activate specially the IGF-2R, could induce apoptosis and reactive oxygen species production in neonatal rat ventricular myocytes. The serum IGF-2R levels were significantly higher in HF patients than those in non-failing control subjects. An unexpected observation is that the serum IGF-2R levels further increased after heart transplantation, peaked at the first month, and gradually reduced close to the levels before heart transplantation at the 6th months after heart transplantation. Serum CD8, a marker of acute rejection, had no change after heart transplantation, but IGF-2R and Granzyme B, as a ligand for the IGF-2R and a marker for CD8 T lymphocyte activation, coexisted in the transplanted hearts. Our preliminary studies suggest that elevation of IGF-2R may participate in pathological process of end-stage HF and involved in the acute cellular rejection after heart transplantation.     

重组人生长激素对老年男性慢性心力衰竭患者血脂代谢影响的研究

目的：探讨重组人生长激素在治疗老年男性慢性心力衰竭时对血脂代谢的影响。方法：将对87例老年慢性心力衰竭患者随机分别进行常规心力衰竭治疗组（CHF对照组）（n=46）和常规治疗基础上加用生长激素治疗组（CHF实验组）（n=41）及正常对照组（n=10）;均连续治疗3个月,观察治疗前后生长激素（GH）、（胰岛素样生长因子-1（IGF-1）、总胆固醇（1℃）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-c）、高密度脂蛋白胆固醇（HDL-C）等各项指标的变化。结果：治疗前,各组之间GH、IGF-1水平无明显差异。治疗后,CHF实验组患者GH（0．71±0．34／350．96±0．48）、IGF-1（95．64±21．11 vs 111．64±23．14）水平较治疗前明显升高,CHF对照组治疗前后GH（0．81±0．32 vs 0．79±0．29）、IGF-1（97．82±19．74 vs 99．65±20．11）水平无明显差异。治疗后CHF实验组与CHF对照组相比GH（0．96±0．48 vs 0．79±0．29）、IGF-1（111．64±23．14 vs 99．65±20．11）水平显著升高（P〈0．05）。治疗前,3组患者血脂各项指标无明显差异（P〉0．05）,治疗后,CHF实验组LDL-C（2．11±0．82 vs 1．76±0．51）、TC（3．78±1．34 vs 3．21±1．17）水平较治疗前有所下降（P〈0．05）,而HDL-C（1．10±0．31 vs 0．99±0．28）、TG（1．89±1．07 vs 1．66±0．95）水平较治疗前无显著差异（P〉0．05）。然而,CHF对照组治疗前、后相比,LDL-C、HDL-C、TC、TG水平无显著差异（P〉0．05）。结论：应用重组人生长激素治疗老年慢性心力衰竭,GH参与了血脂代谢,可降低LDL-C、TC水平,但对HDL-C、TG水平无明显影响。故在长期应用生长激素时需要关注血脂代谢,及时调整血脂治疗。     

Prognostic prediction in acute heart failure patients with extreme BNP values

Background: Some patients have good prognosis despite elevated B-type natriuretic peptide (BNP), while others have ominous outcome with low BNP. We aimed at characterising these groups of patients.

Methods: We analysed patients prospectively included in an acute HF registry. Vital status within 1-year post discharge was ascertained. A receiver–operating characteristic curve was used to define discharge BNP cut-offs for 1-year death prediction. Among survivors, we compared patients with low and not-low BNP (cut-off 400?pg/mL); and among non-survivors those with high vs not-high BNP (cut-off 2000?pg/mL). In the specific subgroups of patients with low and high BNP, mortality predictors were assessed with multivariate Cox-regression analysis.

Results: We studied 584 patients, median age 78 years, 62.5% had HF with reduced ejection fraction; and 199 (34.1%) died during the first year. Non-survivors were very homogeneous irrespective of BNP, survivors were substantially different. In patients discharged with BNP <400?pg/mL, increasing age independently predicted death; when BNP ≥2000?pg/mL death predictors were higher NYHA class, and non-use of evidence-based therapy. BNP was outcome associated in both groups.

Conclusions: Different prognostic predictors may play a role in different BNP levels. We suggest that risk stratification in HF would probably be more accurate if made on top of BNP knowledge.