Mehra Mandeep R, Uber Patricia A, Potluri Srinivasa, Ventura Hector O, Scott Robert L, Park Myung H
Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, Louisiana 70121, USA.
Am J Cardiol. 2004 Aug 15;94(4):454-8. doi: 10.1016/j.amjcard.2004.04.060.
B-type natriuretic peptide (BNP) has emerged as an important marker of ventricular wall stress and is predictive of hemodynamic abnormalities in heart transplantation despite "preserved" systolic function. We evaluated the capacity of BNP to predict deaths due to allograft failure in 62 patients long after heart transplantation (mean 5 +/- 2.5 years). Based on the median tendency of measurement of BNP in the absence of rejection during stable surveillance, 2 distinct patient groups were identified as having low BNP (n = 39, < 250 pg/ml; median BNP 70 pg/ml) and high BNP (n = 23, > or =250 pg/ml; median BNP 592 pg/ml). No differences between the 2 BNP groups were noted with regard to age, gender, race, time after transplantation, diabetes mellitus, hypertension, and hyperlipidemia with measurement of BNP. Multivariable analysis showed that decreased left ventricular ejection fraction, angiographic coronary artery disease, and increased serum creatinine were independent predictors of elevated BNP. Cardiac deaths were significantly greater in those with high BNP levels (35%) than in those with low BNP (2.5%, p = 0.01). Absence of significant angiographic coronary artery disease coupled with a BNP of < 250 pg/ml was associated with the lowest event rate (0%), whereas patients with coronary artery disease and BNP > or =250 pg/ml exhibited a 50% cardiac death rate (p <0.01 for trend). Cox's model confirmed that increased BNP and decreased left ventricular ejection fraction are independent predictors of poor survival. Survival analysis associated lower BNP levels with an excellent long-term survival rate (95%) and higher BNP levels with a markedly decreased survival rate (60%, p = 0.002). Higher BNP levels in patients long after heart transplantation are associated with allograft dysfunction and cardiac allograft vasculopathy and are strongly and independently predictive of cardiovascular death.
B型利钠肽（BNP）已成为心室壁压力的重要标志物，尽管心脏移植患者的收缩功能“保留”，但它仍可预测心脏移植中的血流动力学异常。我们评估了BNP对62例心脏移植术后长期（平均5±2.5年）因移植物衰竭导致死亡的预测能力。根据稳定监测期间无排斥反应时BNP测量的中位数趋势，将2个不同的患者组确定为BNP低（n = 39，<250 pg/ml；中位数BNP 70 pg/ml）和BNP高（n = 23，≥250 pg/ml；中位数BNP 592 pg/ml）。在年龄、性别、种族、移植后时间、糖尿病、高血压和高脂血症方面，这两个BNP组在测量BNP时未发现差异。多变量分析显示，左心室射血分数降低、血管造影显示冠状动脉疾病和血清肌酐升高是BNP升高的独立预测因素。BNP水平高的患者心脏死亡显著高于BNP水平低的患者（35%比2.5%，p = 0.01）。无显著血管造影冠状动脉疾病且BNP<250 pg/ml的患者事件发生率最低（0%），而患有冠状动脉疾病且BNP≥250 pg/ml的患者心脏死亡率为50%（趋势p<0.01）。Cox模型证实，BNP升高和左心室射血分数降低是生存不良的独立预测因素。生存分析表明，较低的BNP水平与良好的长期生存率（95%）相关，而较高的BNP水平与显著降低的生存率（60%，p = 0.002）相关。心脏移植术后长期患者中较高的BNP水平与移植物功能障碍和心脏移植物血管病变相关，并且强烈且独立地预测心血管死亡。
