氨基末端B型利钠肽原作为缺血性心脏病和左心室功能严重受损患者高危冠状动脉搭桥术后恢复的标志物。

Aminoterminal B-type pro-natriuretic peptide as a marker of recovery after high-risk coronary artery bypass grafting in patients with ischemic heart disease and severe impaired left ventricular function.

作者信息

Rothenburger M, Stypmann J, Bruch C, Wichter T, Hoppe M, Drees G, Berendes E, Huelsken G, Loeher A, Welp H, Röttger C, Schmid C, Scheld H H, Tjan T D T

机构信息

Department of Thoracic and Cardiovascular Surgery, University Hospital Muenster, Muenster, Germany.

出版信息

J Heart Lung Transplant. 2006 May;25(5):596-602. doi: 10.1016/j.healun.2005.12.006. Epub 2006 Apr 11.

DOI:10.1016/j.healun.2005.12.006

PMID:16678040

Abstract

BACKGROUND

Aminoterminal B-type pro-natriuretic peptide (NT-proBNP) is a reliable indicator of heart failure severity. Levels of NT-proBNP are markedly increased in patients with coronary artery disease (CAD) and severely impaired left ventricular (LV) function. The aim of our study was to assess the impact of NT-proBNP levels after high-risk coronary artery bypass grafting (CABG) with regard to recovery potential.

METHODS

Between 1998 and 2004, 121 patients with CAD and severely impaired LV function, who were undergoing CABG, were investigated. Their mean age was 64 +/- 11 years. All patients were in New York Heart Association (NYHA) Class III/IV status; LV ejection fraction (EF) was 20 +/- 6%. All survivors underwent follow-up (59 +/- 34 months) spiroergometric, electrocardiographic (ECG) and echocardiographic assessment and were tested for routine blood controls and NT-proBNP levels (Roche, Mannheim, Germany).

RESULTS

The survival rate after 8 years was 70%. All survivors received follow-up assessment. Among survivors the median NT-proBNP level at follow-up was 896 (521 to 1,687) pg/ml. The maximum oxygen uptake was 14.6 +/- 4.9 ml/min/kg, and EF increased to 42% at follow-up among all survivors. On dichotomizing survivors into two groups with NT-proBNP levels above and below the median, the post-operative body mass index was significantly higher in the high NT-proBNP group (p = 0.036). EF (p = 0.028) and NYHA classification (p < 0.05) improved significantly in both groups, with a tendency toward higher EF in the low NT-proBNP group.

CONCLUSIONS

Patients undergoing a high-risk CABG procedure have a survival rate comparable to heart transplantation patients and show a potential for clinical and myocardial recovery. NT-proBNP use a useful marker for recovery after a high-risk CABG procedure, with significant correlation with clinical parameters.

摘要

背景

氨基末端B型利钠肽原（NT-proBNP）是心力衰竭严重程度的可靠指标。冠心病（CAD）和左心室（LV）功能严重受损患者的NT-proBNP水平显著升高。我们研究的目的是评估高危冠状动脉旁路移植术（CABG）后NT-proBNP水平对恢复潜力的影响。

方法

1998年至2004年间，对121例接受CABG且LV功能严重受损的CAD患者进行了调查。他们的平均年龄为64±11岁。所有患者均处于纽约心脏协会（NYHA）III/IV级状态；左心室射血分数（EF）为20±6%。所有幸存者均接受随访（59±34个月），包括运动心肺功能测试、心电图（ECG）和超声心动图评估，并进行常规血液检查和NT-proBNP水平检测（德国曼海姆罗氏公司）。

结果

8年后的生存率为70%。所有幸存者均接受了随访评估。在幸存者中，随访时NT-proBNP水平的中位数为896（521至1687）pg/ml。最大摄氧量为14.6±4.9 ml/min/kg，所有幸存者随访时EF增加到42%。将幸存者分为NT-proBNP水平高于和低于中位数的两组，高NT-proBNP组术后体重指数显著更高（p = 0.036）。两组的EF（p = 0.028）和NYHA分级（p < 0.05）均显著改善，低NT-proBNP组的EF有升高趋势。