对于收缩功能正常的患者，脑钠肽前体能否用作左心室舒张压升高的非侵入性预测指标？

Can pro-brain natriuretic peptide be used as a noninvasive predictor of elevated left ventricular diastolic pressures in patients with normal systolic function?

作者信息

Joung Boyoung, Ha Jong-Won, Ko Young Guk, Kang Seok-Min, Rim Se-Joong, Jang Yangsoo, Chung Namsik, Shim Won-Heum, Cho Seung-Yun

机构信息

Cardiology Division, Yonsei Cardiovascular Hospital and Research Institute, Yonsei University College of Medicine, Seoul, Korea.

出版信息

Am Heart J. 2005 Dec;150(6):1213-9. doi: 10.1016/j.ahj.2005.01.014.

DOI:10.1016/j.ahj.2005.01.014

PMID:16338261

Abstract

OBJECTIVES

This study was sought to investigate whether plasma N-terminal pro-brain natriuretic peptide (proBNP) can help identify patients with an elevated left ventricular end-diastolic pressure (LVEDP) or filling pressures in patients with a normal systolic function.

BACKGROUND

The proBNP is a good predictor of an elevated LVEDP in patients with a systolic dysfunction. However, whether proBNP can predict an elevated LVEDP in patients with a normal systolic function remains to be determined.

METHODS

The LV pressures were measured by fluid-filled catheters in 216 patients (125 men, mean age 60 +/- 10 years) with a normal systolic function (ejection fraction 66% +/- 8%, range 50%-81%) who were undergoing diagnostic cardiac catheterization. The proBNP was sampled at the time of cardiac catheterization and was measured using a quantitative electrochemiluminescence immunoassay.

RESULTS

The log-transformed proBNP levels correlated significantly with the LVEDP (r = 0.33, P = .001) and LV pre-A-wave pressure (pre-A pressure) (r = 0.31, P = .001). An elevated proBNP, defined as >315 pg/mL, predicted an LVEDP > or = 15 mm Hg with a sensitivity of 16% and a specificity of 95% as well as a pre-A pressure > or = 15 mm Hg with a sensitivity of 36% and a specificity of 95%. However, among the 93 patients with an LVEDP > or = 15 mm Hg, 77 (83%) patients had a normal proBNP concentration (< 315 pg/mL).

CONCLUSION

The proBNP level showed weak correlations with the LVEDP and LV pre-A pressure in patients with a normal systolic function. Although high proBNP levels can predict an elevated LV diastolic pressure with high specificity, the sensitivity was quite low. Because the majority of patients with an elevated LVEDP had a normal proBNP, the proBNP level may not be suitable as a screening test for assessing LV filling pressures in the presence of normal systolic function.

摘要

目的

本研究旨在探讨血浆N端前脑钠肽（proBNP）是否有助于识别收缩功能正常的患者中左心室舒张末期压力（LVEDP）升高或充盈压升高的患者。

背景

proBNP是收缩功能障碍患者LVEDP升高的良好预测指标。然而，proBNP是否能预测收缩功能正常的患者LVEDP升高仍有待确定。

方法

对216例（125例男性，平均年龄60±10岁）收缩功能正常（射血分数66%±8%，范围50%-81%）且正在接受诊断性心导管检查的患者，使用充满液体的导管测量左心室压力。在进行心导管检查时采集proBNP样本，并使用定量电化学发光免疫测定法进行测量。

结果

经对数转换的proBNP水平与LVEDP（r = 0.33，P = 0.001）和左心室A波前压力（A波前压力）（r = 0.31，P = 0.001）显著相关。proBNP升高定义为>315 pg/mL，预测LVEDP≥15 mmHg的敏感性为16%，特异性为95%，以及A波前压力≥15 mmHg的敏感性为36%，特异性为95%。然而，在93例LVEDP≥15 mmHg的患者中，77例（83%）患者的proBNP浓度正常（<315 pg/mL）。