Passino Claudio, Poletti Roberta, Bramanti Francesca, Prontera Concetta, Clerico Aldo, Emdin Michele
CNR Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy.
Eur J Heart Fail. 2006 Jan;8(1):46-53. doi: 10.1016/j.ejheart.2005.05.007. Epub 2005 Aug 19.
Heart failure (HF) is characterised by reduced tolerance to effort, associated with progressive fatigue and dyspnoea. Neuro-hormonal activation is a hallmark of HF and influences its clinical evolution.
To evaluate the relationship between neuro-hormonal activation, exercise capacity and ventilatory efficiency.
154 HF patients (127 males, 62 +/- 1 years) underwent cardiopulmonary exercise testing and resting blood sampling for assay of plasma brain natriuretic peptide (BNP), NT-proBNP, norepinephrine, epinephrine, aldosterone and plasma renin activity (PRA). BNP and NT-proBNP levels correlated with peak oxygen consumption (VO2) (both R = -0.53, p < 0.001), VE/VCO2 slope (R = 0.56; p < 0.001 and R = 0.58; p < 0.001, respectively) and maximum workload (R = -0.49; p < 0.001 and R = -0.47; p < 0.001, respectively). Norepinephrine correlated slightly less with peak VO2 (R = -0.38, p < 0.001), VE/VCO2 (R = 0.45; p < 0.001) and maximum workload (R = -0.35; p < 0.001). There was a significant inverse correlation between left ventricular ejection fraction and BNP (R = -0.48, p < 0.001), NT-proBNP (R = -0.42; p < 0.001) and norepinephrine (R = -0.43; p < 0.001). Weaker correlations were found for PRA, exercise parameters and ejection fraction. ROC curves showed that BNP was able to identify patients with peak VO2 < 14 ml/min/kg (cut-off 98 pg/ml, AUC 0.775) and a VE/VCO2 > 35 (cut-off 183 pg/ml, AUC 0.797), as well as NT-proBNP (cut-off 537 pg/ml, AUC 0.799 and cut-off 1010 pg/ml, AUC 0.768, respectively) and norepinephrine (cut-off 454 pg/ml, AUC 0.716 and cut-off 575 pg/ml, AUC 0.783, respectively).
Haemodynamic impairment (as indicated by BNP and NT-proBNP plasma values) and sympathetic activation predict exercise capacity and ventilatory efficiency in HF patients.
心力衰竭（HF）的特征是运动耐力下降，并伴有进行性疲劳和呼吸困难。神经激素激活是HF的一个标志，并影响其临床进展。
评估神经激素激活、运动能力和通气效率之间的关系。
154例HF患者（127例男性，年龄62±1岁）接受了心肺运动试验，并在静息状态下采集血样，以检测血浆脑钠肽（BNP）、N末端脑钠肽前体（NT-proBNP）、去甲肾上腺素、肾上腺素、醛固酮和血浆肾素活性（PRA）。BNP和NT-proBNP水平与峰值耗氧量（VO2）相关（两者R=-0.53，p<0.001）、VE/VCO2斜率（分别为R=0.56；p<0.001和R=0.58；p<0.001）以及最大工作量（分别为R=-0.49；p<0.001和R=-0.47；p<0.001）。去甲肾上腺素与峰值VO2（R=-0.38，p<0.001）、VE/VCO2（R=0.45；p<0.001）和最大工作量（R=-0.35；p<0.001）的相关性稍弱。左心室射血分数与BNP（R=-0.48，p<0.001）、NT-proBNP（R=-0.42；p<0.001）和去甲肾上腺素（R=-0.43；p<0.001）之间存在显著负相关。PRA、运动参数和射血分数之间的相关性较弱。ROC曲线显示，BNP能够识别峰值VO2<14 ml/min/kg（临界值98 pg/ml，AUC 0.775）和VE/VCO2>35（临界值183 pg/ml，AUC 0.797）的患者，NT-proBNP（临界值分别为537 pg/ml，AUC 0.799和1010 pg/ml，AUC 0.768）和去甲肾上腺素（临界值分别为454 pg/ml，AUC 0.716和575 pg/ml，AUC 0.783）也能识别。
血流动力学损害（以血浆BNP和NT-proBNP值表示）和交感神经激活可预测HF患者的运动能力和通气效率。
