Bettencourt P, Ferreira A, Pardal-Oliveira N, Pereira M, Queirós C, Araújo V, Cerqueira-Gomes M, Maciel M J
Hospital S. João, and Faculdade de Medicina da Universidade do Porto, Portugal.
Clin Cardiol. 2000 Dec;23(12):921-7. doi: 10.1002/clc.4960231213.
Risk stratification after acute myocardial infarction (AMI) includes the evaluation of left ventricular (LV) function. Natriuretic peptides, and particularly brain natriuretic peptide (BNP), emerged as a potential marker of ventricular function and prognosis after AMI.
Brain natriuretic peptide levels are related to ventricular function, either systolic or isolated diastolic, and can give prognostic information in patients surviving AMI.
In all, 101 patients were enrolled. An echocardiographic (M-mode, two-dimensional, and pulsed Doppler) evaluation was performed and blood samples for BNP measurement were obtained. Clinical events were recorded during 12 months of follow-up.
A negative correlation between BNP and LV ejection fraction was observed (r = -0.38; p < 0.001). The BNP levels were higher among patients with LV systolic dysfunction than in patients with isolated diastolic dysfunction (339.1 +/- 249.9 vs. 168.0 +/- 110.5 pg/ml, p = 0.001). The latter had higher levels of BNP than those with normal LV function (68.3 +/- 72.6 pg/ml, p < 0.001). The BNP accuracy to detect LV systolic dysfunction was good (area under the ROC curve [AUC] = 0.83) and increased when isolated diastolic dysfunction was also considered (AUC = 0.87). Brain natriuretic peptide had a very good accuracy in the prediction of death (AUC = 0.95) and the development of heart failure (AUC = 0.90).
These results extend previous evidence relating BNP to systolic function after AMI. Furthermore, a relationship between BNP levels and diastolic function was found. Brain natriuretic peptide had a very good performance in detecting the occurrence of an adverse event. We conclude that BNP can detect high-risk patients and help select patients for more aggressive approaches.
急性心肌梗死（AMI）后的风险分层包括对左心室（LV）功能的评估。利钠肽，尤其是脑利钠肽（BNP），成为AMI后心室功能和预后的潜在标志物。
脑利钠肽水平与心室功能相关，无论是收缩功能还是单纯舒张功能，并可为AMI存活患者提供预后信息。
共纳入101例患者。进行了超声心动图（M型、二维和脉冲多普勒）评估，并采集血样用于测量BNP。在12个月的随访期间记录临床事件。
观察到BNP与LV射血分数之间呈负相关（r = -0.38；p < 0.001）。LV收缩功能不全患者的BNP水平高于单纯舒张功能不全患者（339.1±249.9 vs. 168.0±110.5 pg/ml，p = 0.001）。后者的BNP水平高于LV功能正常者（68.3±72.6 pg/ml，p < 0.001）。BNP检测LV收缩功能不全的准确性良好（ROC曲线下面积[AUC] = 0.83），当也考虑单纯舒张功能不全时准确性增加（AUC = 0.87）。脑利钠肽在预测死亡（AUC = 0.95）和心力衰竭发生（AUC = 0.90）方面具有非常好的准确性。
这些结果扩展了先前关于AMI后BNP与收缩功能相关的证据。此外，发现了BNP水平与舒张功能之间的关系。脑利钠肽在检测不良事件的发生方面表现非常好。我们得出结论，BNP可以检测高危患者并有助于选择更积极治疗方案的患者。
