N末端前体脑钠肽作为检测低心功能分级患者和心脏移植候选者的标志物：与运动耐量的线性相关性。
N-terminal prohormone brain natriuretic peptide as a marker for detecting low functional class patients and candidates for cardiac transplantation: linear correlation with exercise tolerance.
作者信息
Kallistratos Manolis S, Dritsas Athanasios, Laoutaris Ioannis D, Cokkinos Dennis V
机构信息
First Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece.
出版信息
J Heart Lung Transplant. 2007 May;26(5):516-21. doi: 10.1016/j.healun.2007.01.026. Epub 2007 Mar 21.
BACKGROUND
N-terminal prohormone brain natriuretic peptide (NT Pro BNP) plasma levels have been associated with indices of left ventricular (LV) function and aerobic capacity in heart failure. The aim of our study was to use NT Pro BNP for the prediction of low functional class patients and also to detect candidates for cardiac transplantation.
METHODS
We studied 100 patients with impaired left ventricular (LV) function. Mean LV ejection fraction (LVEF) was 35% +/- 9%. Blood samples for NT Pro BNP assessment were taken at baseline during treadmill exercise testing. LV cavity diameters, left atrial size, and LVEF were measured by echocardiography.
RESULTS
Plasma levels of NT Pro BNP correlated significantly with peak oxygen consumption (VO(2)) values (r = -0.77, p < 0.001). LVEF correlated well with NT Pro BNP (r = -0.67, p < 0.001). NT Pro BNP plasma levels correlated strongly with New York Heart Association functional class (r = 0.70, p < 0.001). NT Pro BNP values exceeding 335 pg/ml showed 83% sensitivity and 76% specificity for detecting VO(2) values below 20 ml/kg/min (area under the curve [AUC] = 86%, p < 0.001). NT Pro BNP plasma levels exceeding 1,190 pg/ml showed 83% sensitivity and 86% specificity for detecting VO(2) of less than 14 ml/kg/min (AUC = 90%, p < 0.001). NT Pro BNP plasma levels exceeding 1,610 pg/ml showed 87% sensitivity and specificity 82% for detecting VO(2) of less than 10 ml/kg/min (AUC = 90%, p < 0.001). NT Pro BNP plasma levels exceeding 680 pg/ml showed 91% sensitivity and 73% specificity for detecting LVEF of less than 28% (AUC = 86%, p < 0.001).
CONCLUSIONS
NT Pro BNP plasma levels correlate both with LVEF and aerobic capacity, can predict low functional cardiopulmonary exercise capacity in patients with impaired left ventricular function, and are useful for detecting candidates for cardiac transplantation.
背景
N 端前体脑钠肽（NT Pro BNP）血浆水平与心力衰竭患者的左心室（LV）功能指标及有氧运动能力相关。我们研究的目的是使用 NT Pro BNP 来预测低功能分级患者，并检测心脏移植的候选者。
方法
我们研究了 100 例左心室（LV）功能受损的患者。左心室射血分数（LVEF）平均值为 35%±9%。在平板运动试验期间，于基线时采集用于 NT Pro BNP 评估的血样。通过超声心动图测量左心室腔直径、左心房大小和 LVEF。
结果
NT Pro BNP 的血浆水平与峰值耗氧量（VO₂）值显著相关（r = -0.77，p < 0.001）。LVEF 与 NT Pro BNP 相关性良好（r = -0.67，p < 0.001）。NT Pro BNP 血浆水平与纽约心脏协会功能分级密切相关（r = 0.70，p < 0.001）。NT Pro BNP 值超过 335 pg/ml 时，检测 VO₂值低于 20 ml/kg/min 的敏感度为 83%，特异度为 76%（曲线下面积 [AUC] = 86%，p < 0.001）。NT Pro BNP 血浆水平超过 1190 pg/ml 时，检测 VO₂小于 14 ml/kg/min 的敏感度为 83%，特异度为 86%（AUC = 90%，p < 0.001）。NT Pro BNP 血浆水平超过 1610 pg/ml 时，检测 VO₂小于 10 ml/kg/min 的敏感度为 87%，特异度为 82%（AUC = 90%，p < 0.001）。NT Pro BNP 血浆水平超过 680 pg/ml 时，检测 LVEF 小于 28%的敏感度为 91%，特异度为 73%（AUC = 86%，p < 0.001）。
结论
NT Pro BNP 血浆水平与 LVEF 和有氧运动能力均相关，可预测左心室功能受损患者的低心肺运动功能，并有助于检测心脏移植的候选者。
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