Almeida Pedro, Azevedo Ana, Rodrigues Rui, Dias Paula, Friões Fernando, Vazquez Begoña, Abreu-Lima Cassiano, Bettencourt Paulo, Barros Henrique
Serviço de Higiene e Epidemiologia, Faculdade de Medicina da Universidade do Porto, Porto.
Rev Port Cardiol. 2003 Mar;22(3):327-36.
To assess the accuracy of B-type natriuretic peptide (BNP) plasma levels for the diagnosis of left ventricular hypertrophy (LVH) in hypertensive patients.
We studied a sample of 409 adults aged 45 years or older, recruited from residents of Porto by random digit dialing. Data were collected by clinical interview and physical examination, ECG, echocardiogram and venous blood sampling for the measurement of plasma concentrations of BNP. Hypertension (HT) was defined as blood pressure > or = 140/90 mmHg on the day of interview and/or self-reported HT if treated with any antihypertensive medication; LVH was defined as left ventricular mass index (LVMI) > or = 125 g/m2 in men and 110 g/m2 in women. The participants were further classified in four strata according to left ventricular morphology--normal, concentric remodeling, eccentric LVH or concentric LVH.
Two hundred and thirty-two (56.7%) individuals were hypertensive, and among these 73 (31.5%) had LVH. BNP levels were significantly higher in these individuals (median [P25-P75] = 55.8 pg/ml [22.6-88.4]) than in hypertensive patients without LVH (29.9 pg/ml [10.0-62.8]), p = 0.003. BNP levels also differed significantly across strata of left ventricular geometry, the main difference depending on the presence or absence of LVH. There was a positive correlation between plasma BNP levels and LVMI (Spearman's P 0.185, p = 0.005). The area under the ROC curve--a parameter for diagnostic accuracy quantification--was 0.62 (95% confidence interval 0.54-0.70), indicating low discriminatory power between normal and abnormal LVMI.
In the assessed population, BNP levels were higher in hypertensive patients with LVH than in the absence of LVH. However, BNP did not perform well in discriminating between the presence or absence of LVH.
评估B型利钠肽（BNP）血浆水平用于诊断高血压患者左心室肥厚（LVH）的准确性。
我们通过随机数字拨号从波尔图居民中招募了409名45岁及以上的成年人作为样本。通过临床访谈、体格检查、心电图、超声心动图以及静脉血采样来收集数据，以测量血浆BNP浓度。高血压（HT）定义为访谈当天血压≥140/90 mmHg和/或自述接受任何抗高血压药物治疗的高血压；左心室肥厚（LVH）定义为男性左心室质量指数（LVMI）≥125 g/m²，女性≥110 g/m²。参与者根据左心室形态进一步分为四层——正常、向心性重构、离心性LVH或向心性LVH。
232名（56.7%）个体患有高血压，其中73名（31.5%）有左心室肥厚。这些个体的BNP水平（中位数[P25 - P75] = 55.8 pg/ml [22.6 - 88.4]）显著高于无左心室肥厚的高血压患者（29.9 pg/ml [10.0 - 62.8]），p = 0.003。BNP水平在左心室几何形态各层之间也存在显著差异，主要差异取决于是否存在左心室肥厚。血浆BNP水平与LVMI之间存在正相关（Spearman氏ρ 0.185，p = 0.005）。ROC曲线下面积（用于量化诊断准确性的参数）为0.62（95%置信区间0.54 - 0.70），表明在区分正常和异常LVMI方面鉴别能力较低。
在评估人群中，有左心室肥厚的高血压患者的BNP水平高于无左心室肥厚者。然而，BNP在区分是否存在左心室肥厚方面表现不佳。
