Suntharalingam Jay, Goldsmith Kimberley, Toshner Mark, Doughty Natalie, Sheares Karen K, Hughes Rodney, Jenkins David, Pepke-Zaba Joanna
Pulmonary Vascular Diseases Unit, Papworth Hospital NHS Trust, Papworth Everard, Cambridgeshire, CB23 8RE, UK.
Respir Med. 2007 Nov;101(11):2254-62. doi: 10.1016/j.rmed.2007.06.027. Epub 2007 Aug 13.
This study aims to evaluate the role of NT-proBNP and six minute walking distance (6MWD) in the pre- and post-operative assessment of subjects undergoing pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH).
Subjects undergoing PEA between August 2004 and July 2006 were assessed at baseline and 3 months post-operatively with resting haemodynamics, NT-proBNP and 6MWD.
A number of 111 subjects underwent surgery, of which 102 were included. 15 subjects died before their 3 month assessment. Non-survivors had significantly worse preoperative NT-proBNP and 6MWD (4728 pg/mL vs 1863 pg/mL, p=0.001, 182.4 m vs 263.5 m, p=0.001). Taking pre-operative cut-off values of 1200 pg/mL for NT-proBNP and 345 m for 6MWD, both tests had high negative predictive value for predicting mortality (97.3% and 100%, respectively). Amongst survivors, peri-operative changes in NT-proBNP and 6MWD correlated with changes in total pulmonary resistance (TPR) (r=0.49, p<0.001 and r=-0.46, p<0.001). Post-operatively, both NT-proBNP and 6MWD also correlated with mPAP (r=0.65, p<0.001 and r=-0.50, p<0.001) and PVR (r=0.63, p<0.001 and r=-0.47, p<0.001). The ability of NT-proBNP to predict persistent pulmonary hypertension was significantly confounded by age, but not gender, BMI or renal function.
Pre-operative evaluation with NT-proBNP and 6MWD helps risk-stratify patients prior to PEA. Post-operatively, both markers correlate with changes in disease burden and right ventricular function. These results suggest that both NT-proBNP and 6MWD offer effective 'bedside' tools for the long term follow up of patients with CTEPH.
本研究旨在评估N末端B型利钠肽原（NT-proBNP）和六分钟步行距离（6MWD）在慢性血栓栓塞性肺动脉高压（CTEPH）患者接受肺动脉内膜剥脱术（PEA）术前和术后评估中的作用。
对2004年8月至2006年7月期间接受PEA的患者在基线时以及术后3个月进行静息血流动力学、NT-proBNP和6MWD评估。
111例患者接受了手术，其中102例被纳入研究。15例患者在3个月评估前死亡。非幸存者术前NT-proBNP和6MWD明显更差（4728 pg/mL对1863 pg/mL，p = 0.001；182.4 m对263.5 m，p = 0.001）。以术前NT-proBNP的临界值1200 pg/mL和6MWD的临界值345 m计算，这两项检查对预测死亡率均具有较高的阴性预测价值（分别为97.3%和100%）。在幸存者中，NT-proBNP和6MWD的围手术期变化与总肺阻力（TPR）变化相关（r = 0.49，p < 0.001和r = -0.46，p < 0.001）。术后，NT-proBNP和6MWD也与平均肺动脉压（mPAP）（r = 0.65，p < 0.001和r = -0.50，p < 0.001）以及肺血管阻力（PVR）（r = 0.63，p < 0.001和r = -0.47，p < 0.001）相关。NT-proBNP预测持续性肺动脉高压的能力受年龄显著影响，但不受性别、体重指数或肾功能影响。
术前使用NT-proBNP和6MWD进行评估有助于在PEA术前对患者进行风险分层。术后，这两种标志物均与疾病负担和右心室功能的变化相关。这些结果表明，NT-proBNP和6MWD均为CTEPH患者的长期随访提供了有效的“床边”工具。
