Suppr
超能文献

手术性心室修复术后B型利钠肽的变化

Changes in B-type natriuretic peptides after surgical ventricular restoration.

作者信息

Sartipy Ulrik, Albåge Anders, Larsson Per Thomas, Insulander Per, Lindblom Dan

机构信息

Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden.

出版信息

Eur J Cardiothorac Surg. 2007 May;31(5):922-8. doi: 10.1016/j.ejcts.2007.01.038. Epub 2007 Feb 23.

DOI:10.1016/j.ejcts.2007.01.038

PMID:17321144

Abstract

OBJECTIVE

The aim of this study was to prospectively investigate changes in brain natriuretic peptide (BNP) and amino terminal pro-BNP (NT-pro-BNP) in relation to functional status after surgical ventricular restoration (SVR).

METHODS

Between March 2003 and May 2006, 29 patients (20 men and 9 women, mean age 65 years, mean ejection fraction 24%) with post-infarction left ventricular aneurysm and depressed left ventricular function underwent SVR according to the Dor technique at our institution. Twenty-two patients (76%) were in New York heart association (NYHA) functional class III or IV. Multi-vessel disease was present in 26 patients. Natriuretic peptides, functional status, ejection fraction and left ventricular volumes were analyzed at baseline, after 6 months, and late postoperatively.

RESULTS

There was no early mortality. Survival at 24 months was 93%. Six months postoperatively 25/29 (86%) patients were in NYHA class I and II (p<0.001) and at late (mean 21 months) follow-up, all patients were in NYHA class I and II. There was a persistent reduction of NT-pro-BNP (2406 pg/ml vs 1510 pg/ml; p=0.03 and 975 pg/ml; p=0.03) and BNP (312 pg/ml vs 228 pg/ml; p=0.12 and 191 pg/ml; p=0.20) 6 months postoperatively and at late follow-up, respectively. Ejection fraction improved from 24% to 37% (p<0.001) at 6 months. End-diastolic (110 ml/m(2) vs 90 ml/m(2), p=0.009) and end-systolic (75 ml/m(2) vs 52 ml/m(2), p=0.006) volume index were reduced at 6 months. Functional improvement correlated significantly with reduction in BNP (r=0.61, p=0.01) and NT-pro-BNP (r=0.58, p=0.003) 6 months after surgery. Ejection fraction correlated inversely with BNP (r=-0.58, p=0.02) and NT-pro-BNP (r=-0.51, p=0.04), and end-systolic volume correlated with BNP (r=0.65, p=0.03) and NT-pro-BNP (r=0.62, p=0.03) 6 months after surgery.

CONCLUSIONS

Heart failure secondary to post-infarction left ventricular remodeling can be reversed by SVR. Improvement in these patients was associated with reduced levels of B-type natriuretic peptides 6 months after surgery. Clinical improvement was maintained and peptide levels were further reduced at late follow-up.

摘要

目的

本研究旨在前瞻性调查外科心室修复术（SVR）后脑钠肽（BNP）和氨基末端脑钠肽前体（NT-pro-BNP）与功能状态相关的变化。

方法

2003年3月至2006年5月间，29例（20例男性和9例女性，平均年龄65岁，平均射血分数24%）患有心肌梗死后左心室室壁瘤且左心室功能低下的患者在我院接受了根据Dor技术进行的SVR。22例患者（76%）为纽约心脏协会（NYHA）心功能Ⅲ级或Ⅳ级。26例患者存在多支血管病变。在基线、术后6个月及术后晚期对利钠肽、功能状态、射血分数和左心室容积进行分析。

结果

无早期死亡病例。24个月时的生存率为93%。术后6个月，25/29例（86%）患者为NYHAⅠ级和Ⅱ级（p<0.001），在晚期（平均21个月）随访时，所有患者均为NYHAⅠ级和Ⅱ级。术后6个月及晚期随访时，NT-pro-BNP持续降低（分别为2406 pg/ml对1510 pg/ml；p=0.03和975 pg/ml；p=0.03），BNP也持续降低（分别为312 pg/ml对228 pg/ml；p=0.12和191 pg/ml；p=0.20）。术后6个月射血分数从24%提高到37%（p<0.001）。6个月时舒张末期容积指数（110 ml/m²对90 ml/m²，p=0.009）和收缩末期容积指数（75 ml/m²对52 ml/m²，p=0.006）降低。术后6个月功能改善与BNP降低（r=0.61，p=0.01）和NT-pro-BNP降低（r=0.58，p=0.003）显著相关。术后6个月射血分数与BNP呈负相关（r=-0.58，p=0.02）和NT-pro-BNP呈负相关（r=-0.51，p=0.04），收缩末期容积与BNP呈正相关（r=0.65，p=0.03）和NT-pro-BNP呈正相关（r=0.62，p=0.03）。