Riezebos Robert K, Ronner Eelko, Tijssen Jan G P, Laarman Gert-Jan
Amsterdam Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Acute Card Care. 2006;8(1):51-7. doi: 10.1080/14628840600627972.
To explore the relationship between NT-proBNP elevation and prognosis in patients with NSTEACS.
High NT-proBNP levels are related to a worse prognosis in patients with ACS. The precise mechanism by which is not clear.
Serial sampling of NT-proBNP, Troponin T and CK-MB was performed in 23 patients admitted with NSTEACS. Using coronary angiography in each patient a culprit lesion was identified. Proximal lesions were located before or at the first major branch of the parent artery. All other lesions localizations were considered distal. To evaluate the influence of left ventricular systolic function on NT-proBNP levels WMSI was measured by echocardiography.
Proximal culprit lesion localization was associated with significant higher baseline (mean 506 ng/l, SD 440 ng/l) and peak NT-proBNP levels (mean 1055 ng/l; SD 236 ng/l), as compared to patients with a distal lesion localization. (Baseline: 139 ng/l, SD 140 ng/l, peak: 381 ng/l; SD 64 ng/l). (P = 0.01) NT-proBNP levels were highly correlated to Troponin T and CK-MB peak serum levels. Adjustments for left ventricular dysfunction did not alter these associations.
High peak NT-proBNP levels are independently associated with both proximal culprit localization and elevated biochemical markers of myocardial damage. These findings suggest that NT-proBNP levels reflect the amount of jeopardized myocardium and could signify the integral of the extent and severity of an ischemic event.
探讨非ST段抬高型急性冠脉综合征（NSTEACS）患者N末端B型利钠肽原（NT-proBNP）升高与预后的关系。
急性冠脉综合征（ACS）患者NT-proBNP水平升高与预后较差相关。其确切机制尚不清楚。
对23例因NSTEACS入院的患者进行NT-proBNP、肌钙蛋白T和肌酸激酶同工酶（CK-MB）的系列采样。通过冠状动脉造影确定每位患者的罪犯病变。近端病变位于母动脉的第一个主要分支之前或该分支处。所有其他病变部位均视为远端病变。为评估左心室收缩功能对NT-proBNP水平的影响，采用超声心动图测量左心室心肌质量指数（WMSI）。
与远端病变定位的患者相比，近端罪犯病变定位与显著更高的基线NT-proBNP水平（平均506 ng/l，标准差440 ng/l）和峰值NT-proBNP水平（平均1055 ng/l；标准差236 ng/l）相关。（基线：139 ng/l，标准差140 ng/l，峰值：381 ng/l；标准差64 ng/l）。（P = 0.01）NT-proBNP水平与肌钙蛋白T和CK-MB血清峰值水平高度相关。对左心室功能障碍进行校正并未改变这些关联。
NT-proBNP峰值水平升高与近端罪犯病变定位及心肌损伤生化标志物升高均独立相关。这些发现表明，NT-proBNP水平反映了心肌受损的程度，可能预示着缺血事件的范围和严重程度。
