Arquès S, Roux E, Sbragia P, Pieri B, Gélisse R, Luccioni R, Ambrosi P
Service de cardiolgie, centre hospitalier général, 13400 Aubagne.
Arch Mal Coeur Vaiss. 2007 Feb;100(2):113-20.
B-type natriuretic peptide (BNP) has been largely validated in the etiologic diagnosis of acute dyspnea. Nevertheless, its reliability in the setting of a preserved left ventricular systolic function (ejection fraction >50%) has not been adequately established.
the study addressed the usefulness of BNP in the diagnosis of new-onset heart failure with a preserved systolic function in hypertensive patients hospitalized for acute dyspnea.
59 consecutive hypertensive patients without history of heart failure and coronary disease were included. BNP was measured at presentation with the Triage system. Noninvasive estimation of left ventricular filling pressures by bedside tissue Doppler echocardiography at presentation was incorporated in the diagnostic criteria.
the 30 patients with heart failure were not significantly different from the 29 patients with noncardiac cause of acute dyspnea regarding age, gender, body mass index and ejection fraction. Median levels of BNP were significantly higher in heart failure (447 [245-644] versus 87 [43-139] pg/mL). By multivariate logistic regression analysis, BNP (odds ratio of 44, [3.6-531], p=0.003) provided independent and incremental diagnostic information over the clinical score of Boston criteria (2.25, [1.3-3.9], p=0.0037). A BNP value of >142 pg/mL (area under the ROC curve of 0.89, p<0.0001) was 93 sensitive and 79% specific for the diagnosis of heart failure in this setting.
BNP is a reliable biomarker of new-onset heart failure with a preserved systolic function in hypertensive patients, in particular older, hospitalized for acute dyspnea and can be safely integrated in the diagnostic strategy.
B型利钠肽（BNP）在急性呼吸困难的病因诊断中已得到广泛验证。然而，其在左心室收缩功能保留（射血分数>50%）情况下的可靠性尚未得到充分证实。
本研究探讨BNP在因急性呼吸困难住院的高血压患者中诊断收缩功能保留的新发心力衰竭的实用性。
纳入59例无心力衰竭和冠心病病史的连续高血压患者。入院时使用Triage系统测定BNP。诊断标准纳入床边组织多普勒超声心动图对入院时左心室充盈压的无创估计。
30例心力衰竭患者与29例急性呼吸困难非心脏病因患者在年龄、性别、体重指数和射血分数方面无显著差异。心力衰竭患者的BNP中位数水平显著更高（447[245 - 644]对87[43 - 139]pg/mL）。通过多因素逻辑回归分析，BNP（优势比为44，[3.6 - 531]，p = 0.003）比波士顿标准的临床评分（2.25，[1.3 - 3.9]，p = 0.0037）提供了独立且增量的诊断信息。在这种情况下，BNP值>142 pg/mL（ROC曲线下面积为0.89，p<0.0001）对心力衰竭诊断的敏感性为93%，特异性为79%。
BNP是高血压患者收缩功能保留的新发心力衰竭的可靠生物标志物，特别是对于因急性呼吸困难住院的老年患者，可安全地纳入诊断策略。
