cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2020.4.n788cardio-788Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИRESEARCH ARTICLESСкрининг на бессимптомную сердечную недостаточность с сохраненной фракцией выброса в монгольской популяции с высоким рискомScreening for asymptomatic heart failure with preserved ejection fraction in mongolian population at high riskУнуржаргалЦ.UnurjargalTs.chingerel@mnums.edu.mnhttps://orcid.org/0000-0003-2348-6931ХорлооЧ.KhorlooCh.chingerel@mnums.edu.mnУлзийсайханГ.UlziisaikhanG.ganaa.u@gmail.comhttps://orcid.org/0000-0002-1455-9687СодовсурэнН.SodovsurenN.naranchimeg@mnums.edu.mnХасагА.KhasagA.altaisaikhan@mnums.edu.mnМонгольский национальный университет медицинских наукМонголияMongolian National University of Medical SciencesMongoliaМонгольский национальный университет медицинских наукМонголияCardiovascular center, Third State Central HospitalMongoliaCardiovascular Center, Third State Central HospitalМонголияCardiovascular Center, Third State Central HospitalMongolia2020270320206048690Copyright © Kardiomag, 20202020KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/788

Цель Целью настоящего исследования было оценить распространенность бессимптомной сердечной недостаточности с сохраненной фракцией выброса (HFpEF) у субъектов с высоким риском развития СН и определить диагностическую точность анализа NT-pro BNP по сравнению с эхокардиографией у таких пациентов.Материал и методы В перекрестное исследование были включены пациенты в возрасте от 35 до 64 лет с высоким риском сердечной недостаточности, у которых не было клинических симптомов сердечной недостаточности. Факторы риска сердечной недостаточности были выявлены при клинических исследованиях. Определение NT-pro BNP проводили с использованием иммуноанализатора (FIA8000, Getein Bio Medical Inc, Китай), который использует полоску реагента для получения количественных результатов NT-pro BNP в цельной крови или плазме. Точка отсечения для NT-pro BNP составляла 125 пг/мл. Диагностика HFpEF основывалась на критериях, описанных в рекомендациях ESC по сердечной недостаточности 2016 года. Диастолическая дисфункция оценивалась по алгоритму, предложенному в совместных рекомендациях ASE / EACVI.Результаты В исследование были включены 602 пациента с факторами риска сердечной недостаточности, из которых 256 (42,5%) были мужчинами и 346 (57,5%) женщинами. Средний возраст составлял 51,71±8,07 года. 83 пациента (13,8%) имели повышенные уровни NT-pro BNP ≥125 пг/мл. Наше исследование показало, что концентрация NT-pro BNP положительно коррелирует с возрастом, уровнем АД, массой миокарда левого желудочка и отношением E/e‘, и отрицательно коррелирует с окружностью талии, индексом массы тела, ФВ ЛЖ и E/A соотношение в бессимптомной популяции. Вероятность положительного теста NT-pro BNP была независимо (р<0,05) связана с возрастом, гипертонией и диабетом. Диагноз бессимптомного HFpEF был подтвержден у 12,3% исследуемой популяции. Предельное значение 125 пг/мл для концентрации NT-proBNP показало следующие диагностические возможности при выявлении бессимптомной СНпФВ: чувствительность 85,0%, специфичность 88,6% и площадь под кривой 0,92 (95% ДИ 0,86-0,98).Заключение Субъекты с повышенным уровнем NT-pro BNP (≥125 пг/мл) с большей вероятностью имели подтвержденный диагноз бессимптомной СНпФВ после скрининга. Таким образом, в популяции группы риска скрининг на основе натрийуретического пептида в сочетании с эхокардиографией выявляет высокую распространенность бессимптомной СНпФВ.

Objective The goals of the present study were to assess the prevalence of asymptomatic heart failure with preserved ejection fraction (HFpEF) in subjects at high risk of developing HF and to define the diagnostic accuracy of NT-pro BNP assay compared with echocardiography in this setting.Material and methods This cross-sectional study included subjects aged from 35 to 64 years, with high risk of HF, who had no clinical symptoms of HF. Risk factors of HF were detected by clinical examinations. NT-pro BNP determination was performed using immunoassay analyzer (FIA8000, Getein Bio Medical Inc, China),. The cut-off point for NT-pro BNP was 125 pg/ml. Diagnosis of HFpEF was based on criteria recommended by 2016 ESC heart failure guidelines. Diastolic dysfunction was assessed according to the algorithm proposed in the joint recommendations of the ASE/EACVI.Results 602 patients with risk factors of HF were included in the study, of which 256 (42.5 %) were males and 346 (57.5 %) females. The mean age was 51.71±8.07 years. 83 patients (13.8 %) showed elevated NT-pro BNP levels of ≥125 pg / ml. Our study has shown that NT-pro BNP concentration was positively correlating with age, both systolic and diastolic blood pressure, left ventricular mass and E / e’ ratio and negatively correlating with waist circumference, body mass index, left ventricular EF and E / A ratio in asymptomatic population. The likelihood of positive NT-pro BNP test was independently (p<0.05) associated with age, hypertension and diabetes. The diagnosis of asymptomatic HFpEF was confirmed in 12.3 % of studied population. A cutoff value of 125 pg / ml for NT-proBNP concentration showed the following diagnostic re-abilities in identifying asymptomatic HFpEF: sensitivity 85.0 %, specificity 88.6 % and area under curve 0.92 (95 % CI 0.86–0.98).Conclusion Subjects with raised NT-pro BNP level (≥125 pg/ml) were more likely to have a confirmed diagnosis of asymptomatic HFpEF after screening. In summary, in at-risk population, natriuretic peptide based screening combined with echocardiography identifies high prevalence of asymptomatic HFpEF.

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The authors declare that there are no conflicts of interest present.