B型利钠肽水平在无症状性舒张功能障碍诊断中的应用

B-type natriuretic peptide level in the diagnosis of asymptomatic diastolic dysfunction.

作者信息

Karaca Ilgin, Gülcü Erden, Yavuzkir Mustafa, Dağli Necati, Ilkay Erdoğan, Ozbay Yilmaz, Işik Ahmet, Arslan Nadi

机构信息

Department of Cardiology, Medical School, Firat University, Elaziğ, Turkey.

出版信息

Anadolu Kardiyol Derg. 2007 Sep;7(3):262-7.

PMID:17785213

Abstract

OBJECTIVE

Brain natriuretic peptide (BNP) reflects the left ventricular pressure and volume overload. It is known that it increases in systolic dysfunction proportionally with left ventricular pressure increase. The BNP levels are well correlated with NYHA classification and prognosis. Our aim was to evaluate the predictive value of BNP in patients with diastolic dysfunction but normal systolic dysfunction demonstrated by echocardiography.

METHODS

Fifty patients (mean age: 48.5+/-6.75 years; 29 males, 21 females) were included in this cross-sectional, case-controlled study. Systolic dysfunction was the exclusion criterion. The following parameters were used to evaluate diastolic function: isovolumetric relaxation time, transmitral early to late filling flow velocities (E/A) ratio, deceleration time E, pulmonary vein Doppler findings and color mitral flow propagation velocity. Diastolic dysfunction was determined in 30 hypertensive patients (Group 1), whereas 20 patients who had normal diastolic flow patterns on echocardiography (Group 2). Blood samples were taken for serum BNP level measurements.

RESULTS

The BNP levels were 12.0+/-4.97 pg/ml in individuals with normal filling pattern and 66.17+/-17.56 pg/ml in individuals with abnormal filling patterns (p<0.001). The accuracy of BNP in detection of diastolic dysfunction was assessed with receiver-operating characteristic (ROC) analysis. The area under the ROC curve for BNP test accuracy in detection any abnormal diastolic dysfunction was 0.969 (95% CI, 0.909 to 1.029; p<0.001). A BNP value of 37.0 pg/ml had sensitivity of 80%, specificity of 100%, a positive predictive value of 100%, a negative predictive value of 23% and accuracy of 88% in identifying asymptomatic prolonged relaxation pattern. We found a strong correlation between left ventricular mass index and plasma BNP levels (r=0.62, p<0.05).

CONCLUSION

Estimation of BNP values could be accepted as a fast and reliable blood test in the diagnosis of asymptomatic diastolic dysfunction.

摘要

目的

脑钠肽（BNP）反映左心室压力和容量超负荷。已知在收缩功能障碍时，其随着左心室压力升高而成比例增加。BNP水平与纽约心脏协会（NYHA）分级及预后密切相关。我们的目的是评估BNP对经超声心动图证实为舒张功能障碍但收缩功能正常的患者的预测价值。

方法

本横断面病例对照研究纳入了50例患者（平均年龄：48.5±6.75岁；男性29例，女性21例）。收缩功能障碍为排除标准。采用以下参数评估舒张功能：等容舒张时间、二尖瓣血流舒张早期与晚期流速（E/A）比值、E波减速时间、肺静脉多普勒检查结果及二尖瓣血流彩色传播速度。30例高血压患者（第1组）存在舒张功能障碍，而20例超声心动图舒张血流模式正常的患者（第2组）。采集血样测定血清BNP水平。

结果

充盈模式正常者的BNP水平为12.0±4.97 pg/ml，充盈模式异常者为66.17±17.56 pg/ml（p<0.001）。采用受试者工作特征（ROC）分析评估BNP检测舒张功能障碍的准确性。BNP检测任何异常舒张功能障碍的ROC曲线下面积为0.969（95%可信区间，0.909至1.029；p<0.001）。BNP值为37.0 pg/ml时，识别无症状性舒张期延长模式的敏感性为80%，特异性为100%，阳性预测值为100%，阴性预测值为23%，准确性为88%。我们发现左心室质量指数与血浆BNP水平之间存在强相关性（r=0.62，p<0.05）。