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Preoperative plasma N-terminal pro-brain natriuretic peptide as a marker of cardiac risk in patients undergoing elective non-cardiac surgery.术前血浆N末端脑钠肽前体作为择期非心脏手术患者心脏风险的标志物。
Br J Surg. 2005 Aug;92(8):1041-5. doi: 10.1002/bjs.4947.
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Optimizing the prediction of perioperative mortality in vascular surgery by using a customized probability model.使用定制概率模型优化血管外科围手术期死亡率预测
Arch Intern Med. 2005 Apr 25;165(8):898-904. doi: 10.1001/archinte.165.8.898.
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N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease.N 末端前 B 型利钠肽与稳定型冠心病的长期死亡率
N Engl J Med. 2005 Feb 17;352(7):666-75. doi: 10.1056/NEJMoa042330.
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Coronary-artery revascularization before elective major vascular surgery.择期大血管手术前的冠状动脉血运重建。
N Engl J Med. 2004 Dec 30;351(27):2795-804. doi: 10.1056/NEJMoa041905.
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Analysis of N-terminal-pro-brain natriuretic peptide and C-reactive protein for risk stratification in stable and unstable coronary artery disease: results from the AtheroGene study.分析N末端前脑钠肽和C反应蛋白用于稳定型和不稳定型冠状动脉疾病的危险分层：动脉粥样硬化基因研究结果
Eur Heart J. 2005 Feb;26(3):241-9. doi: 10.1093/eurheartj/ehi036. Epub 2004 Nov 30.
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N-terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients.N末端前脑钠肽可预测心力衰竭患者出院后的预后。
Circulation. 2004 Oct 12;110(15):2168-74. doi: 10.1161/01.CIR.0000144310.04433.BE. Epub 2004 Sep 27.
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Essential biochemistry and physiology of (NT-pro)BNP.（N-末端前体脑钠肽）的基础生物化学与生理学
Eur J Heart Fail. 2004 Mar 15;6(3):257-60. doi: 10.1016/j.ejheart.2003.12.015.
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N-terminal pro-brain natriuretic peptide. A new gold standard in predicting mortality in patients with advanced heart failure.N末端前脑钠肽。预测晚期心力衰竭患者死亡率的一项新的金标准。
Eur Heart J. 2003 Oct;24(19):1735-43. doi: 10.1016/j.ehj.2003.07.005.
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Brain natriuretic peptide and n-terminal brain natriuretic peptide in the diagnosis of heart failure in patients with acute shortness of breath.脑钠肽和N末端脑钠肽在急性呼吸急促患者心力衰竭诊断中的应用
J Am Coll Cardiol. 2003 Aug 20;42(4):728-35. doi: 10.1016/s0735-1097(03)00787-3.
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N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utilization of Strategies To Open occluded arteries (GUSTO)-IV substudy.N末端前脑钠肽及其他风险标志物对不稳定型冠状动脉疾病患者死亡率和后续心肌梗死的单独预测：开放闭塞动脉全球策略（GUSTO）-IV子研究
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血浆N末端B型利钠肽原作为大血管手术后的长期预后标志物。

Plasma N-terminal pro-B-type natriuretic peptide as long-term prognostic marker after major vascular surgery.

作者信息

Feringa Harm H H, Schouten Olaf, Dunkelgrun Martin, Bax Jeroen J, Boersma Eric, Elhendy Abdou, de Jonge Robert, Karagiannis Stefanos E, Vidakovic Radosav, Poldermans Don

机构信息

Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.

出版信息

Heart. 2007 Feb;93(2):226-31. doi: 10.1136/hrt.2006.093716. Epub 2006 Aug 16.

DOI:10.1136/hrt.2006.093716
PMID:16914484
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1861400/
Abstract

OBJECTIVE

To assess the long-term prognostic value of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) after major vascular surgery.

DESIGN

A single-centre prospective cohort study.

PATIENTS

335 patients who underwent abdominal aortic aneurysm repair or lower extremity bypass surgery.

INTERVENTIONS

Prior to surgery, baseline NT-proBNP level was measured. Patients were also evaluated for cardiac risk factors according to the Revised Cardiac Risk Index. Dobutamine stress echocardiography (DSE) was performed to detect stress-induced myocardial ischaemia.

MAIN OUTCOME MEASURES

The prognostic value of NT-proBNP was evaluated for the endpoints all-cause mortality and major adverse cardiac events (MACE) during long-term follow-up.

RESULTS

In this patient cohort (mean age: 62 years, 76% male), median NT-proBNP level was 186 ng/l (interquartile range: 65-444 ng/l). During a mean follow-up of 14 (SD 6) months, 49 patients (15%) died and 50 (15%) experienced a MACE. Using receiver operating characteristic curve analysis for 6-month mortality and MACE, NT-proBNP had the greatest area under the curve compared with cardiac risk score and DSE. In addition, an NT-proBNP level of 319 ng/l was identified as the optimal cut-off value to predict 6-month mortality and MACE. After adjustment for age, cardiac risk score, DSE results and cardioprotective medication, NT-proBNP > or =319 ng/l was associated with a hazard ratio of 4.0 for all-cause mortality (95% CI: 1.8 to 8.9) and with a hazard ratio of 10.9 for MACE (95% CI: 4.1 to 27.9).

CONCLUSION

Preoperative NT-proBNP level is a strong predictor of long-term mortality and major adverse cardiac events after major non-cardiac vascular surgery.

摘要

目的

评估大血管手术后血浆N末端B型利钠肽原（NT-proBNP）的长期预后价值。

设计

单中心前瞻性队列研究。

患者

335例行腹主动脉瘤修复术或下肢搭桥手术的患者。

干预措施

术前测量基线NT-proBNP水平。根据修订的心脏风险指数对患者的心脏危险因素进行评估。进行多巴酚丁胺负荷超声心动图（DSE）以检测应激诱导的心肌缺血。

主要观察指标

评估NT-proBNP对长期随访期间全因死亡率和主要不良心脏事件（MACE）终点的预后价值。

结果

在该患者队列中（平均年龄：62岁，76%为男性），NT-proBNP水平中位数为186 ng/l（四分位间距：65 - 444 ng/l）。在平均14（标准差6）个月的随访期间，49例患者（15%）死亡，50例（15%）发生MACE。使用受试者工作特征曲线分析6个月死亡率和MACE，与心脏风险评分和DSE相比，NT-proBNP的曲线下面积最大。此外，NT-proBNP水平319 ng/l被确定为预测6个月死亡率和MACE的最佳截断值。在调整年龄、心脏风险评分、DSE结果和心脏保护药物后，NT-proBNP≥319 ng/l与全因死亡率的风险比为4.0（95%可信区间：1.8至8.9），与MACE的风险比为10.9（95%可信区间：4.1至27.9）。

结论

术前NT-proBNP水平是重大非心脏血管手术后长期死亡率和主要不良心脏事件的有力预测指标。