Cheng V, Kazanagra R, Garcia A, Lenert L, Krishnaswamy P, Gardetto N, Clopton P, Maisel A
Division of Cardiology, Veteran's Affairs Medical Center, San Diego, California, USA.
J Am Coll Cardiol. 2001 Feb;37(2):386-91. doi: 10.1016/s0735-1097(00)01157-8.
The goal of this study was to determine if B-type natriuretic peptide (BNP) levels predict outcomes of patients admitted with decompensated heart failure.
Treatment of decompensated congestive heart failure (CHF) has often been based on titration of drugs to relieve patient's symptoms, a case that could be made for attempting to also treat neurohormonal abnormalities. Because BNP reflects both elevated left ventricular pressure as well as neurohormonal modulation, we hypothesized that BNP might be useful in assessing outcomes in patients admitted with decompensated CHF.
We followed 72 patients admitted with decompensated New York Heart Association class III to IV CHF, measuring daily BNP levels. We then determined the association between initial BNP measurement and the predischarge or premoribund BNP measurement and subsequent adverse outcomes (death and 30-day readmission).
Of the 72 patients admitted with decompensated CHF, 22 end points occurred (death: n = 13, readmission: n = 9). In these patients, BNP levels increased during hospitalization (mean increase, 233 pg/ml, p < 0.001). In patients without end points, BNP decreased (mean decrease 215 pg/ml). Univariate analysis revealed that the last measured BNP was strongly associated with the combined end point. In patients surviving hospitalization, BNP discharge concentrations were strong predictors of subsequent readmission (area under the receiver operator curve of 0.73).
In patients admitted with decompensated CHF, changes in BNP levels during treatment are strong predictors for mortality and early readmission. The results suggest that BNP levels might be used successfully to guide treatment of patients admitted for decompensated CHF.
本研究的目的是确定B型利钠肽（BNP）水平是否能预测失代偿性心力衰竭患者的预后。
失代偿性充血性心力衰竭（CHF）的治疗通常基于调整药物剂量以缓解患者症状，也可以尝试治疗神经激素异常。由于BNP既反映左心室压力升高，也反映神经激素调节，我们假设BNP可能有助于评估失代偿性CHF患者的预后。
我们对72例纽约心脏协会III至IV级失代偿性CHF患者进行了随访，每天测量BNP水平。然后我们确定初始BNP测量值与出院前或濒死前BNP测量值以及随后不良结局（死亡和30天再入院）之间的关联。
在72例失代偿性CHF患者中，发生了22个终点事件（死亡：n = 13，再入院：n = 9）。在这些患者中，住院期间BNP水平升高（平均升高233 pg/ml，p < 0.001）。在没有终点事件的患者中，BNP水平下降（平均下降215 pg/ml）。单因素分析显示，最后测量的BNP与综合终点密切相关。在存活至出院的患者中，出院时BNP浓度是随后再入院的有力预测指标（受试者操作特征曲线下面积为0.73）。
在失代偿性CHF患者中，治疗期间BNP水平的变化是死亡率和早期再入院的有力预测指标。结果表明，BNP水平可能成功用于指导失代偿性CHF患者的治疗。
