Feola Mauro, Aspromonte Nadia, Milani Loredano, Bobbio Marco, Bardellotto Stefania, Barro Sabrina, Giovinazzo Prospero, Noventa Federica, Valle Roberto
Department of Cardiovascular Diseases Ospedale Santa Croce-Carle Cuneo, Cuneo, Italy.
J Card Fail. 2008 Jun;14(5):420-5. doi: 10.1016/j.cardfail.2008.01.013. Epub 2008 May 27.
Plasma brain natriuretic peptide (BNP) is an important parameter of severity in congestive heart failure (CHF). We analyzed if BNP might stratify 6-month clinical outcome in outpatients with CHF with restrictive mitral filling pattern.
All subjects with New York Heart Association (NYHA) class II to IV and restrictive filling pattern were enrolled at hospital discharge after an acute decompensation. NYHA class, BNP, and echocardiogram for the evaluation of left ventricular ejection fraction (LVEF) and diastolic function were analyzed. Death and hospital readmission for CHF were the clinical events observed.
A total of 250 patients (66% were male, mean age 73 years) were enrolled. The mean NYHA class was 2.5 +/- 0.6, LVEF was 38% +/- 15%, and mean deceleration time was 120 +/- 16 ms. The mean BNP was 643 +/- 566 pg/mL. During the 6-month follow-up, 35 patients (14%) died and 106 patients (42.4%) were readmitted for CHF (event group); in 109 patients (43.6%) no events were observed (no-event group). Higher NYHA class (2.7 +/- 0.6 vs 2.4 +/- 0.6, P = .001) and reduced LVEF (34% +/- 13% vs 42% +/- 17%, P = .01) but similar deceleration time (119 +/- 16 ms vs 122 +/- 17 ms, P = not significant) were observed in the event group. A higher level of mean BNP (833 +/- 604 pg/mL vs 397 +/- 396 pg/mL, P = .01) was recorded in the event group. The multivariate Cox analysis confirmed that LVEF (P = .04), NYHA class (P = .02), and plasma BNP (P = .0001) were associated with adverse short-term clinical outcome.
Patients with CHF with a restrictive diastolic pattern had poor short-term clinical outcome. NYHA class and LVEF at discharge might predict cardiovascular events, but plasma BNP proved to be the strongest predictor.
血浆脑钠肽（BNP）是充血性心力衰竭（CHF）严重程度的一个重要参数。我们分析了BNP是否可对舒张功能呈限制性二尖瓣血流频谱模式的CHF门诊患者6个月的临床结局进行分层。
所有纽约心脏协会（NYHA）心功能II至IV级且舒张功能呈限制性模式的患者在急性失代偿后出院时纳入研究。分析NYHA心功能分级、BNP以及用于评估左心室射血分数（LVEF）和舒张功能的超声心动图。观察的临床事件为CHF导致的死亡和再次入院。
共纳入250例患者（66%为男性，平均年龄73岁）。平均NYHA心功能分级为2.5±0.6，LVEF为38%±15%，平均减速时间为120±16毫秒。平均BNP为643±566 pg/mL。在6个月的随访期间，35例患者（14%）死亡，106例患者（42.4%）因CHF再次入院（事件组）；109例患者（43.6%）未观察到事件（无事件组）。事件组中NYHA心功能分级更高（2.7±0.6对2.4±0.6, P = .001），LVEF降低（34%±13%对42%±17%, P = .01），但减速时间相似（119±16毫秒对122±17毫秒, P = 无统计学意义）。事件组记录到更高水平的平均BNP（833±604 pg/mL对397±396 pg/mL, P = .01）。多因素Cox分析证实LVEF（P = .04）、NYHA心功能分级（P = .02）和血浆BNP（P = .0001）与不良短期临床结局相关。
舒张功能呈限制性模式的CHF患者短期临床结局较差。出院时的NYHA心功能分级和LVEF可能预测心血管事件，但血浆BNP被证明是最强的预测指标。
