Kahveci Gokhan, Bayrak Fatih, Mutlu Bulent, Bitigen Atila, Karaahmet Tansu, Sonmez Kenan, Izgi Akin, Degertekin Muzaffer, Basaran Yelda
Department of Cardiology, Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
Am J Cardiol. 2007 May 15;99(10):1429-33. doi: 10.1016/j.amjcard.2006.12.071. Epub 2007 Apr 5.
Our aim was to determine whether N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and cardiac troponin I (cTnI) levels are valuable for predicting prognosis in patients with infective endocarditis (IE). We analyzed measured plasma NT-pro-BNP levels at admission in 45 patients with definite IE. The primary end point was early surgery or in-hospital death. The other data recorded were baseline clinical, echocardiographic, and laboratory parameters. Thirty patients underwent early surgery, and 9 died in hospital. Univariate analysis revealed that log NT-pro-BNP, cTnI > or =0.03 ng/ml, New York Heart Association functional class III to IV symptoms, left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and severe valvular regurgitation were associated with increased risk of reaching the primary end point. Cox proportional hazard regression analysis identified log NT-pro-BNP (hazard ratio 1.5; 95% confidence interval 1.2 to 1.9, p <0.001) as the only independent predictor of the primary end point. The log NT-pro-BNP cut-off value with the highest sensitivity (97%) and specificity (92%) for predicting primary end point was 7.2 (1,500 pg/ml). Patients with NT-pro-BNP level > or =1,500 pg/ml had significantly lower event-free survival than others. In conclusion, admission NT-pro-BNP is of prognostic value in patients with IE. The combination of admission NT-pro-BNP and cTnI levels appears to have even greater value for risk stratification in this patient group.
我们的目的是确定N末端B型利钠肽原（NT-pro-BNP）和心肌肌钙蛋白I（cTnI）水平对于预测感染性心内膜炎（IE）患者的预后是否有价值。我们分析了45例确诊IE患者入院时测定的血浆NT-pro-BNP水平。主要终点是早期手术或院内死亡。记录的其他数据包括基线临床、超声心动图和实验室参数。30例患者接受了早期手术，9例在医院死亡。单因素分析显示，log NT-pro-BNP、cTnI≥0.03 ng/ml、纽约心脏协会功能分级III至IV级症状、左心房直径、左心室舒张末期直径、左心室收缩末期直径和严重瓣膜反流与达到主要终点的风险增加相关。Cox比例风险回归分析确定log NT-pro-BNP（风险比1.5；95%置信区间1.2至1.9，p<0.001）是主要终点的唯一独立预测因子。预测主要终点的灵敏度最高（97%）和特异性最高（92%）的log NT-pro-BNP临界值为7.2（1500 pg/ml）。NT-pro-BNP水平≥1500 pg/ml的患者无事件生存率明显低于其他患者。总之，入院时的NT-pro-BNP对IE患者具有预后价值。入院时NT-pro-BNP和cTnI水平的联合似乎对该患者群体的风险分层具有更大的价值。
