Aspromonte Nadia, Feola Mauro, Scardovi Angela Beatrice, Coletta Claudio, D'Eri Alessandra, Giovinazzo Prospero, Carunchio Alessandro, Chiera Antonella, Fanelli Renato, Di Giacomo Tiziana, Ricci Roberto, Ceci Vincenzo, Milani Loredano, Valle Roberto
Heart Failure Unit, Department of Cardiology, Santo Spirito Hospital, Rome, Italy.
J Cardiovasc Med (Hagerstown). 2006 Jun;7(6):406-13. doi: 10.2459/01.JCM.0000228690.40452.d3.
B-type natriuretic peptide (BNP) has emerged as an important diagnostic serum marker of congestive heart failure (CHF). The aim of this study was to evaluate whether BNP measurement associated with echocardiography could effectively stratify patients with new symptoms as part of a cost-effective heart failure programme based on cooperation between hospital cardiologists and primary care physicians.
Patients were referred to the cardiology clinic by general practitioners in case of clinical suspect of CHF. All patients underwent clinical examination, transthoracic echocardiography and plasma determination of BNP. Systolic dysfunction was defined as a left ventricular ejection fraction < 45%; diastolic dysfunction was defined as a preserved systolic function with signs of diastolic impairment.
Three hundred and fifty-seven subjects were examined (50% males, mean age 73 years). BNP concentration was 469 +/- 505 pg/ml in the 240 patients diagnosed with CHF, compared with 43 +/- 105 pg/ml in the 117 patients without CHF (P = 0.001). CHF patients were grouped into those with diastolic dysfunction (n = 110; BNP 373 +/- 335 pg/ml), systolic dysfunction (n = 108; BNP 550 +/- 602 pg/ml), and both systolic and diastolic dysfunction (n = 22; BNP 919 +/- 604 pg/ml). At receiver operating characteristic analysis, the optimal BNP cut-off level for diagnosing CHF was 80 pg/ml (sensitivity 84%, specificity 91%). According to cost analysis, this cut-off level might provide a cost saving of 31% without affecting diagnostic accuracy.
In patients referred by general practitioners for suspected CHF, plasma BNP levels might help to stratify subjects into different groups of cardiac dysfunction.
B型利钠肽（BNP）已成为充血性心力衰竭（CHF）重要的血清诊断标志物。本研究旨在评估与超声心动图相关的BNP检测能否作为医院心脏病专家与基层医疗医生合作开展的具有成本效益的心力衰竭项目的一部分，有效地对有新症状的患者进行分层。
全科医生在临床怀疑CHF时将患者转诊至心脏病诊所。所有患者均接受临床检查、经胸超声心动图检查及血浆BNP测定。收缩功能障碍定义为左心室射血分数<45%；舒张功能障碍定义为收缩功能正常但有舒张功能受损迹象。
共检查了357名受试者（50%为男性，平均年龄73岁）。240例诊断为CHF的患者BNP浓度为469±505 pg/ml，117例无CHF的患者BNP浓度为43±105 pg/ml（P = 0.001）。CHF患者分为舒张功能障碍组（n = 110；BNP 373±335 pg/ml）、收缩功能障碍组（n = 108；BNP 550±602 pg/ml）和收缩与舒张功能障碍组（n = 22；BNP 919±604 pg/ml）。在受试者工作特征分析中，诊断CHF的最佳BNP临界值为80 pg/ml（敏感性84%，特异性91%）。根据成本分析，该临界值可在不影响诊断准确性的情况下节省31%的成本。
对于全科医生转诊的疑似CHF患者，血浆BNP水平可能有助于将受试者分层为不同的心脏功能障碍组。
