McClure Samuel J, Gall Scott, Schechter Clyde B, Kearney Mark, Zaman Azfar G
Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom.
J Am Coll Cardiol. 2007 Jun 26;49(25):2394-7. doi: 10.1016/j.jacc.2007.02.064. Epub 2007 Jun 11.
The purpose of this work was to assess the effect of percutaneous coronary revascularization (PCR) on plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration.
Left ventricular (LV) dysfunction is associated with increased plasma natriuretic peptide concentrations. The effect of ischemia resolution on plasma natriuretic peptide is not known.
Twenty-six patients with stable angina, normal LV systolic function, and isolated stenoses of the left anterior descending (LAD) coronary artery were studied. All patients had angiographically and physiologically significant lesions defined by cine-angiography and intracoronary pressure wire.
After revascularization, 24 patients demonstrated significant decrease in mean plasma NT-proBNP 8 weeks after PCR (from 177.2 +/- 190.8 pg/ml to 105.0 +/- 92.4 pg/ml, p = 0.03). The mean decrease in log NT-proBNP was 0.533, corresponding to geometric mean decrease of NT-proBNP by a factor of 59% (95% confidence interval 48.2% to 71.4%, p < 0.00005). Reduction in NT-proBNP was independent of change in LV systolic function.
This study demonstrates that removal of fixed LAD stenosis reduces plasma NT-proBNP concentration. This has implications for interpretation of natriuretic peptide levels in clinical settings and as screening tool for LV systolic dysfunction.
本研究旨在评估经皮冠状动脉血运重建术（PCR）对血浆N端前脑钠肽（NT-proBNP）浓度的影响。
左心室（LV）功能障碍与血浆利钠肽浓度升高有关。缺血缓解对血浆利钠肽的影响尚不清楚。
对26例稳定型心绞痛、左心室收缩功能正常且左前降支（LAD）冠状动脉孤立性狭窄的患者进行研究。所有患者均经电影血管造影和冠状动脉内压力导丝确定存在血管造影和生理学上有意义的病变。
血运重建后，24例患者在PCR术后8周时血浆NT-proBNP均值显著降低（从177.2±190.8 pg/ml降至105.0±92.4 pg/ml，p = 0.03）。NT-proBNP对数均值下降0.533，相当于NT-proBNP几何均值下降59%（95%置信区间48.2%至71.4%，p < 0.00005）。NT-proBNP的降低与左心室收缩功能的变化无关。
本研究表明，解除LAD固定狭窄可降低血浆NT-proBNP浓度。这对临床环境中利钠肽水平的解读以及作为左心室收缩功能障碍的筛查工具具有重要意义。
