Tung Poyee P, Olmsted Elise, Kopelnik Alexander, Banki Nader M, Drew Barbara J, Ko Nerissa, Lawton Michael T, Smith Wade, Foster Elyse, Young William L, Zaroff Jonathan G
Division of Cardiology, University of California, San Francisco, CA, USA.
Stroke. 2005 Jul;36(7):1567-9. doi: 10.1161/01.STR.0000170699.59783.d6. Epub 2005 Jun 9.
Serum B-type natriuretic peptide (BNP) is elevated after subarachnoid hemorrhage (SAH), as well as in the setting of congestive heart failure and myocardial infarction. The aim of this study was to prospectively quantify the relationship between BNP levels and cardiac outcomes after SAH.
Plasma was collected for BNP measurements as soon as possible after enrollment; a mean of 5+/-4 days after SAH symptom onset. On days 1, 3, and 6 after enrollment, troponin I (cTi) was measured and 2-dimensional echocardiography was performed. The following cardiac variables were collected and treated dichotomously: left ventricular ejection fraction (LVEF), regional wall motion abnormalities (RWMA), diastolic dysfunction, pulmonary edema, and cTi.
There were 57 subjects. The median BNP level was 141 pg/mL (range, 0.8 to 3330 pg/mL). Higher mean BNP levels were present in those with RWMA (550 versus 261 pg/mL; P=0.012), diastolic dysfunction (360 versus 44; P=0.011), pulmonary edema (719 versus 204; P=0.016), elevated cTi (662 versus 240; P=0.004), and LVEF <50% (644 versus 281; P=0.015).
Early after SAH, elevated BNP levels are associated with myocardial necrosis, pulmonary edema, and both systolic and diastolic dysfunction of the left ventricle. These findings support the hypothesis that the heart releases BNP into the systemic circulation early after SAH.
蛛网膜下腔出血（SAH）后血清B型利钠肽（BNP）水平升高，在充血性心力衰竭和心肌梗死时也是如此。本研究的目的是前瞻性地量化SAH后BNP水平与心脏结局之间的关系。
入组后尽快采集血浆用于BNP检测；SAH症状发作后平均5±4天。在入组后的第1、3和6天，检测肌钙蛋白I（cTi）并进行二维超声心动图检查。收集以下心脏变量并进行二分法处理：左心室射血分数（LVEF）、节段性室壁运动异常（RWMA）、舒张功能障碍、肺水肿和cTi。
共有57名受试者。BNP水平中位数为141 pg/mL（范围为0.8至3330 pg/mL）。RWMA患者（550 vs 261 pg/mL；P=0.012）、舒张功能障碍患者（360 vs 44；P=0.011）、肺水肿患者（719 vs 204；P=0.016）、cTi升高患者（662 vs 240；P=0.004）以及LVEF<50%的患者（644 vs 281；P=0.015）的平均BNP水平较高。
SAH后早期，BNP水平升高与心肌坏死、肺水肿以及左心室的收缩和舒张功能障碍相关。这些发现支持了SAH后早期心脏将BNP释放到体循环中的假说。
