Yusoff Rahal, Clayton Nigel, Keevil Brian, Morris Julie, Ray Simon
Department of Cardiology, South Manchester University Hospitals, Wythenshawe, Manchester, United Kingdom.
Am J Cardiol. 2006 May 15;97(10):1498-501. doi: 10.1016/j.amjcard.2005.11.085. Epub 2006 Mar 29.
Plasma levels of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) are elevated in severe mitral regurgitation, but their relation to functional capacity and cardiac remodeling is not well defined. We evaluated the role of NT-pro-BNP as a marker of functional capacity, symptoms, and cardiac remodeling in 38 patients with severe degenerative mitral regurgitation and preserved left ventricular ejection fraction. The NT-pro-BNP levels increased progressively with New York Heart Association (NYHA) functional class: NYHA class I (geometric mean [GM] 97.1 pg/ml), NYHA class II (GM 169.8 pg/ml), and NYHA III (GM 457.6 pg/ml; p = 0.015). The end-systolic volume index (r = 0.52, p = 0.001), end-diastolic volume index (r = 0.46, p = 0.003), left atrial volume index (r = 0.4, p = 0.01), regurgitant volume index (r = 0.38, p = 0.02), regurgitant fraction (r = 0.46, p = 0.003), and end-diastolic sphericity index (r = 0.56, p <0.001) all correlated significantly with NT-pro-BNP. The NT-pro-BNP levels correlated significantly with the exercise parameters: maximum oxygen uptake (r = -0.6, p <0.001), exercise time (r = -0.52, p <0.001), and oxygen pulse (r = -0.57, p <0.001). In contrast, only weak correlations were obtained between the exercise and echocardiographic variables. NT-pro-BNP was a strong independent predictor of maximum oxygen uptake (p = 0.001). In conclusion, the results of this study have demonstrated that NT-pro-BNP increases progressively with worsening symptoms, is linked to the extent of LV remodeling, and is an independent predictor of functional capacity. NT-pro-BNP may have a role in the optimal treatment of patients with severe mitral regurgitation.
严重二尖瓣反流患者的血浆N末端脑钠肽前体（NT-pro-BNP）水平升高，但其与心功能和心脏重塑的关系尚不明确。我们评估了NT-pro-BNP作为38例严重退行性二尖瓣反流且左心室射血分数保留患者的心功能、症状和心脏重塑标志物的作用。NT-pro-BNP水平随纽约心脏协会（NYHA）心功能分级逐渐升高：NYHA I级（几何均数[GM] 97.1 pg/ml）、NYHA II级（GM 169.8 pg/ml）和NYHA III级（GM 457.6 pg/ml；p = 0.015）。收缩末期容积指数（r = 0.52，p = 0.001）、舒张末期容积指数（r = 0.46，p = 0.003）、左心房容积指数（r = 0.4，p = 0.01）、反流容积指数（r = 0.38，p = 0.02）、反流分数（r = 0.46，p = 0.003）和舒张末期球形指数（r = 0.56，p <0.001）均与NT-pro-BNP显著相关。NT-pro-BNP水平与运动参数显著相关：最大摄氧量（r = -0.6，p <0.001）、运动时间（r = -0.52，p <0.001）和氧脉搏（r = -0.57，p <0.001）。相比之下，运动与超声心动图变量之间仅存在弱相关性。NT-pro-BNP是最大摄氧量的强有力独立预测因子（p = 0.001）。总之，本研究结果表明，NT-pro-BNP随症状恶化而逐渐升高，与左心室重塑程度相关，是心功能的独立预测因子。NT-pro-BNP可能在严重二尖瓣反流患者的优化治疗中发挥作用。
