X综合征合并左束支传导阻滞且收缩功能保留患者的循环N端脑钠肽前体和内皮素水平

Circulating N-terminal brain natriuretic peptide precursor and endothelin levels in patients with syndrome X and left bundle branch block with preserved systolic function.

作者信息

Dudek D, Rzeszutko L, Petkow Dimitrow P, Bartus S, Sorysz D, Chyrchel M, Rakowski T, Zdzienicka A, Guevara I, Dembinska-Kiec A, Dubiel J S

机构信息

IInd Department of Cardiology, Jagiellonian University, Kopernika 17, 31-501, Krakow, Poland.

出版信息

Int J Cardiol. 2001 Jun;79(1):25-30. doi: 10.1016/s0167-5273(01)00400-4.

DOI:10.1016/s0167-5273(01)00400-4

PMID:11399338

Abstract

BACKGROUND

Deterioration of left ventricular function during follow-up was reported in some patients with syndrome X and concomitant left bundle branch block. The patients with syndrome X and left bundle branch block has been frequently presented with elevated Endothelin-1 (ET-1) level while brain natriuretic peptide (BNP) (a sensitive marker of left ventricular dysfunction) has not been measured in patients with syndrome X.

METHODS

The purpose of the present study was to assess left ventricular diastolic function, levels of N-terminal Brain Natriuretic Peptide (NT-proBNP) precursor and biochemical parameters of endothelial function in patients with syndrome X complicated by left bundle branch block but preserved left ventricular systolic function (group A, n=8). The echocardiographic and neurohormonal measures in these patients were compared to those in patients with syndrome X without left bundle branch block (group B, n=13), and controls (group C, n=15).

RESULTS

At rest and after exercise the serum concentration of NT-proBNP was significantly higher in group A than in the controls (at rest: 232+/-96 vs. 133+/-23 fmol/ml, P=0.03; after exercise: 313+/-96 vs. 180+/-33 fmol/ml, P=0.02). The highest concentration of endothelin-1 was also found in group A, being significantly higher than in the controls (6.81 vs. 4.52 pg/ml, P<0.05). Mitral flow abnormalities were detected in left bundle branch block patients. Accordingly, the lowest E/A ratio was in group A and it differed significantly from that in group C (0.85 vs. 1.1, P<0.05). E/A ratio inversely correlated with plasma NT-proBNP concentration in patients with left bundle branch block (r=-0.48, P=0.02).

CONCLUSIONS

Elevated NT-proBNP and endothelin-1 plasma concentrations were demonstrated in patients with syndrome X complicated by left bundle branch block even when left ventricular systolic function was still preserved. In this subgroup the magnitude of left ventricular diastolic dysfunction correlated with the increase of BNP level which reflects neurohormonal activation.

摘要

背景

一些患有X综合征并伴有左束支传导阻滞的患者在随访期间出现左心室功能恶化。X综合征合并左束支传导阻滞的患者常出现内皮素-1（ET-1）水平升高，而X综合征患者尚未检测脑钠肽（BNP，左心室功能障碍的敏感标志物）。

方法

本研究的目的是评估合并左束支传导阻滞但左心室收缩功能保留的X综合征患者的左心室舒张功能、N末端脑钠肽前体（NT-proBNP）水平和内皮功能生化参数（A组，n = 8）。将这些患者的超声心动图和神经激素指标与无左束支传导阻滞的X综合征患者（B组，n = 13）及对照组（C组，n = 15）进行比较。

结果

静息时和运动后，A组血清NT-proBNP浓度显著高于对照组（静息时：232±96 vs. 133±23 fmol/ml，P = 0.03；运动后：313±96 vs. 180±33 fmol/ml，P = 0.02）。A组还发现内皮素-1浓度最高，显著高于对照组（6.81 vs. 4.52 pg/ml，P < 0.05）。在左束支传导阻滞患者中检测到二尖瓣血流异常。因此，A组E/A比值最低，与C组有显著差异（0.85 vs. 1.1，P < 0.05）。左束支传导阻滞患者中E/A比值与血浆NT-proBNP浓度呈负相关（r = -0.48，P = 0.02）。