Maisel Alan S, McCord James, Nowak Richard M, Hollander Judd E, Wu Alan H B, Duc Philippe, Omland Torbjørn, Storrow Alan B, Krishnaswamy Padma, Abraham William T, Clopton Paul, Steg Gabriel, Aumont Marie Claude, Westheim Arne, Knudsen Cathrine Wold, Perez Alberto, Kamin Richard, Kazanegra Radmila, Herrmann Howard C, McCullough Peter A
Cardiology 111-A, San Diego VA Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
J Am Coll Cardiol. 2003 Jun 4;41(11):2010-7. doi: 10.1016/s0735-1097(03)00405-4.
This study examines B-type natriuretic peptide (BNP) levels in patients with systolic versus non-systolic dysfunction presenting with shortness of breath.
Preserved systolic function is increasingly common in patients presenting with symptoms of congestive heart failure (CHF) but is still difficult to diagnose.
The Breathing Not Properly Multinational Study was a seven-center, prospective study of 1,586 patients who presented with acute dyspnea and had BNP measured upon arrival. A subset of 452 patients with a final adjudicated diagnosis of CHF who underwent echocardiography within 30 days of their visit to the emergency department (ED) were evaluated. An ejection fraction of greater than 45% was defined as non-systolic CHF.
Of the 452 patients with a final diagnosis of CHF, 165 (36.5%) had preserved left ventricular function on echocardiography, whereas 287 (63.5%) had systolic dysfunction. Patients with non-systolic heart failure (NS-CHF) had significantly lower BNP levels than those with systolic heart failure (S-CHF) (413 pg/ml vs. 821 pg/ml, p < 0.001). As the severity of heart failure worsened by New York Heart Association class, the percentage of S-CHF increased, whereas the percentage of NS-CHF decreased. When patients with NS-CHF were compared with patients without CHF (n = 770), a BNP value of 100 pg/ml had a sensitivity of 86%, a negative predictive value of 96%, and an accuracy of 75% for detecting abnormal diastolic dysfunction. Using Logistic regression to differentiate S-CHF from NS-CHF, BNP entered first as the strongest predictor followed by oxygen saturation, history of myocardial infarction, and heart rate.
We conclude that NS-CHF is common in the setting of the ED and that differentiating NS-CHF from S-CHF is difficult in this setting using traditional parameters. Whereas BNP add modest discriminatory value in differentiating NS-CHF from S-CHF, its major role is still the separation of patients with CHF from those without CHF.
本研究检测了因呼吸急促就诊的收缩功能障碍与非收缩功能障碍患者的B型利钠肽（BNP）水平。
在出现充血性心力衰竭（CHF）症状的患者中，保留收缩功能的情况越来越常见，但仍难以诊断。
“呼吸不畅”多国研究是一项在七个中心开展的前瞻性研究，共纳入1586例因急性呼吸困难就诊且入院时检测了BNP的患者。对其中452例最终确诊为CHF且在急诊科（ED）就诊后30天内接受了超声心动图检查的患者进行了评估。射血分数大于45%被定义为非收缩性CHF。
在452例最终诊断为CHF的患者中，165例（36.5%）超声心动图显示左心室功能保留，而287例（63.5%）存在收缩功能障碍。非收缩性心力衰竭（NS-CHF）患者的BNP水平显著低于收缩性心力衰竭（S-CHF）患者（413 pg/ml对821 pg/ml，p<0.001）。随着纽约心脏协会分级中心力衰竭严重程度的加重，S-CHF的比例增加，而NS-CHF的比例下降。将NS-CHF患者与无CHF患者（n = 770）进行比较时，BNP值为100 pg/ml检测舒张功能异常的敏感性为86%，阴性预测值为96%，准确性为75%。使用逻辑回归区分S-CHF和NS-CHF时，BNP首先作为最强预测因子进入模型，其次是血氧饱和度、心肌梗死病史和心率。
我们得出结论，NS-CHF在ED环境中很常见，在此环境下使用传统参数难以区分NS-CHF和S-CHF。虽然BNP在区分NS-CHF和S-CHF方面增加了适度的鉴别价值，但其主要作用仍然是区分CHF患者和无CHF患者。
