Scardovi A B, Coletta C, Aspromonte N, Perna S, Infusino T, Carunchio A, D'Errigo P, Seccareccia F, De Maria R, Greggi M, Di Giacomo T, Ricci R, Ceci V
Division of Cardiology, S. Spirito Hospital, Rome, Italy.
Minerva Cardioangiol. 2005 Aug;53(4):313-20.
Aim of the study was to evaluate if brain natriuretic peptide (BNP) levels, a cardiac neurohormone well correlated with prognosis in chronic heart failure (CHF), are associated with enhanced ventilatory response to exercise, in ambulatory patients with intermediate peak oxygen uptake (PVO2).
Resting BNP was measured in 129 consecutive stable CHF patients with mild to moderate heart failure (90% New York Heart Association (NYHA) class II or III) and intermediate (10-18 mL/kg/min) PVO2, assessed during cardiopulmonary exercise test. Mean (SD) left ventricular ejection fraction (EF) and pulmonary systolic pressure (PAP) were 41 +/- 3% and 47 +/- 14 mmHg, respectively. The enhanced ventilatory response to exercise (EVR) was assessed as a slope of the relation between minute ventilation and carbon dioxide production (VE/VCO2 slope) > 35.
Thirty-three over 129 patients (26%) had EVR. Mean BNP plasma level was 394 +/- 347 pg/mL. A significant correlation between BNP and EVR (r = 0.310; p < 0.01), was observed. In the logistic multivariate model, a BNP plasma level > 100 pg/mL had an independent predictive value for EVR (95% IC 1.68 to 10.5, Odds Ratio 4.23, p = 0.02). We found a significant correlation between BNP and PAP (r = 0.390; p < 0.001), and between PAP and EVR (r = 0.511; p < 0.01).
In CHF patients with intermediate PVO2, plasma BNP is clearly related to the enhanced ventilatory response to exercise. In this subset, BNP levels could represent an effective alternative tool for the clinical assessment in patients with unreliable cardiopulmonary exercise test.
本研究旨在评估在峰值摄氧量（PVO2）处于中等水平的非卧床患者中，与慢性心力衰竭（CHF）预后密切相关的心脏神经激素脑钠肽（BNP）水平是否与运动时通气反应增强相关。
对129例连续的稳定CHF患者进行静息BNP测量，这些患者患有轻度至中度心力衰竭（90%为纽约心脏协会（NYHA）II级或III级）且PVO2处于中等水平（10 - 18 mL/kg/min），通过心肺运动试验进行评估。平均（标准差）左心室射血分数（EF）和肺动脉收缩压（PAP）分别为41±3%和47±14 mmHg。运动时通气反应增强（EVR）通过分钟通气量与二氧化碳产生量之间关系的斜率（VE/VCO2斜率）> 35来评估。
129例患者中有33例（26%）出现EVR。血浆BNP平均水平为394±347 pg/mL。观察到BNP与EVR之间存在显著相关性（r = 0.310；p < 0.01）。在逻辑多元模型中，血浆BNP水平> 100 pg/mL对EVR具有独立预测价值（95%置信区间1.68至10.5，比值比4.23，p = 0.02）。我们发现BNP与PAP之间存在显著相关性（r = 0.390；p < 0.001），以及PAP与EVR之间存在显著相关性（r = 0.511；p < 0.01）。
在PVO2处于中等水平的CHF患者中，血浆BNP与运动时通气反应增强明显相关。在这一亚组中，BNP水平可能是心肺运动试验结果不可靠患者临床评估的有效替代工具。
Zotero 插件