脑钠肽是心力衰竭患者心肺运动试验期间通气异常的可靠指标。

Brain natriuretic peptide is a reliable indicator of ventilatory abnormalities during cardiopulmonary exercise test in heart failure patients.

作者信息

Scardovi Angela Beatrice, De Maria Renata, Colettat Claudio, Aspromonte Nadia, Perna Silvia, Infusino Tommaso, D'Errigo Paola, Rosato Stefano, Greggi Manuela, Di Giacomo Tiziana, Riccio Roberto, Cec Vincenzo

机构信息

Cardiology Department, S. Spirito Hospital, Rome, Italy.

出版信息

Med Sci Monit. 2006 May;12(5):CR191-5.

PMID:16641874

Abstract

BACKGROUND

Whether brain natriuretic peptide (BNP), a neurohormone marker of ventricular dysfunction, correlates with an enhanced ventilatory response (EVR) during cardiopulmonary exercise test, a well-known predictor of prognosis, in systolic heart failure (HF) is currently unknown.

MATERIAL/METHODS: Resting BNP was measured in 134 consecutive stable outpatients aged 69 +/- 11 years with mild to moderate HF and LV ejection fraction (LVEF) < 40% who performed a maximal exercise test. EVR was assessed as the slope of the relation between minute ventilation and carbon dioxide production (VE/VCO2 slope) > or = 35.

RESULTS

LVEF averaged 33 +/- 7%, BNP 350 +/- 396 pg/ml, and the VE/VCO2 slope 36 +/- 8. Fifty-six of 123 patients (45%) had EVR. BNP correlated with VE/VCO2 slope (r = 0.453; p < 0.01). By multivariate logistic regression, plasma BNP was the only independent predictor of EVR (RR: 1.004 per unit increment, 95% CI: 1.002-1.006, p < 0.0001). A BNP > or = 160 pg/ml had 86% sensitivity, 67% specificity, and 76% overall accuracy for the prediction of EVR (chi square: 37.4, RR 12.2, 95% CI: 4.96-30.3, p < 0.0001, AUC 0.815 (95%CI. 0.738-0.892)).

CONCLUSIONS

In systolic HF, plasma BNP is related to an enhanced ventilatory response to exercise and offers a simple and reliable alternative to the cardiopulmonary exercise test in patients with inability or contraindications to exercise.

摘要

背景

脑钠肽（BNP）作为心室功能障碍的一种神经激素标志物，在收缩性心力衰竭（HF）患者中，与心肺运动试验期间增强的通气反应（EVR）是否相关尚不清楚。心肺运动试验是一种众所周知的预后预测指标。

材料/方法：对134例年龄69±11岁、轻度至中度HF且左心室射血分数（LVEF）<40%的连续稳定门诊患者进行静息BNP测量，这些患者均进行了最大运动试验。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。

结果

LVEF平均为33±7%，BNP为350±396 pg/ml，VE/VCO2斜率为36±8。123例患者中有56例（45%）出现EVR。BNP与VE/VCO2斜率相关（r = 0.453；p < 0.01）。通过多因素逻辑回归分析，血浆BNP是EVR的唯一独立预测因子（RR：每单位增量为1.004，95%CI：1.002 - 1.006，p < 0.0001）。BNP≥160 pg/ml对EVR预测的敏感性为86%，特异性为67%，总体准确性为76%（卡方值：37.4，RR 12.2，95%CI：4.96 - 30.3，p < 0.0001，AUC 0.815（95%CI：0.738 - 0.892））。