Karavidas Apostolos, Lazaros George, Matsakas Evangelos, Farmakis Dimitrios, Parissis John, Paraskevaidis Ioannis A, Michailidis Christos, Avramidis Dimitrios, Zacharoulis Achilleas, Arapi Sophia, Kaoukis Andreas, Zacharoulis Apostolos
Department of Cardiology, Athens General Hospital, Achilleos 31, Athens, Greece.
Heart Vessels. 2008 May;23(3):181-6. doi: 10.1007/s00380-007-1022-9. Epub 2008 May 17.
Invasive hemodynamic monitoring with Swan-Ganz catheterization to guide treatment decisions in heart failure may be hazardous and may lack prognostic value. We assessed the clinical utility of B-type natriuretic peptide (BNP) in estimating left ventricular filling pressures in patients with inconclusive tissue Doppler indexes. In this study, 50 patients with systolic heart failure and an early transmitral velocity to early diastolic mitral annular velocity ratio (E/Ea) between 8 and 15 were studied. Among them, 25 had been admitted for acutely decompensated heart failure (group A) and the remainder were clinically stable outpatients (group B). All patients underwent simultaneous invasive pulmonary capillary wedge pressure (PCWP) determination, BNP measurement, and echocardiography. In group A, BNP correlated with PCWP (r = 0.803, P < 0.001), deceleration time (DT, r = -0.602, p = 0.001), and end-systolic wall stress (SWS, r = 0.565, P = 0.003). In multivariate analysis, BNP was the only parameter independently associated with PCWP (P = 0.023). In group B, no correlation was found between BNP and PCWP or SWS, while DT correlated significantly with both PCWP (r = -0.817, P < 0.001) and BNP (r = -0.8, P < 0.001). We conclude that BNP may be a useful noninvasive tool for the assessment of left ventricular filling pressures in patients with acutely decompensated heart failure and inconclusive tissue Doppler indexes.
使用 Swan-Ganz 导管进行有创血流动力学监测以指导心力衰竭的治疗决策可能具有危险性，且可能缺乏预后价值。我们评估了 B 型利钠肽（BNP）在评估组织多普勒指数不明确的患者左心室充盈压方面的临床效用。在本研究中，对 50 例收缩性心力衰竭且二尖瓣血流舒张早期峰值速度与二尖瓣环舒张早期峰值速度之比（E/Ea）在 8 至 15 之间的患者进行了研究。其中，25 例因急性失代偿性心力衰竭入院（A 组），其余为临床稳定的门诊患者（B 组）。所有患者均同时进行了有创肺毛细血管楔压（PCWP）测定、BNP 测量和超声心动图检查。在 A 组中，BNP 与 PCWP 相关（r = 0.803，P < 0.001）、减速时间（DT，r = -0.602，p = 0.001）和收缩末期壁应力（SWS，r = 0.565，P = 0.003）。在多变量分析中，BNP 是唯一与 PCWP 独立相关的参数（P = 0.023）。在 B 组中，未发现 BNP 与 PCWP 或 SWS 之间存在相关性，而 DT 与 PCWP（r = -0.817，P < 0.001）和 BNP（r = -0.8，P < 0.001）均显著相关。我们得出结论，对于急性失代偿性心力衰竭且组织多普勒指数不明确的患者，BNP 可能是一种有用的无创评估左心室充盈压的工具。
