B型利钠肽和C端前内皮素-1用于预测严重受损的最大摄氧量。

B-type natriuretic peptide and C-terminal-pro-endothelin-1 for the prediction of severely impaired peak oxygen consumption.

作者信息

Maeder M T, Brutsche M H, Staub D, Morgenthaler N G, Bergmann A, Noveanu M, Laule K, Breidthardt T, Christ A, Klima T, Reichlin T, Potocki M, Mueller C

机构信息

Division of Cardiology, University Hospital Basel, Basel, Switzerland.

出版信息

J Intern Med. 2009 May;265(5):604-15. doi: 10.1111/j.1365-2796.2009.02071.x. Epub 2009 Feb 16.

DOI:10.1111/j.1365-2796.2009.02071.x

PMID:19226375

Abstract

OBJECTIVE

To assess the utility of B-type natriuretic peptide (BNP) and C-terminal-pro-endothelin-1 (CT-proET-1) to predict a severely impaired peak oxygen consumption (peak VO(2), < 14 mL kg(-1) min(-1)) in patients referred for cardiopulmonary exercise testing.

DESIGN

Cross-sectional study.

SETTING

Tertiary care center.

METHODS

Peak VO(2), BNP and CT-proET-1 were assessed in 141 consecutive patients referred for cardiopulmonary exercise testing.

RESULTS

B-type natriuretic peptide [median (interquartile range) 48 (38-319) vs. 33 (15-86) pg mL(-1); P = 0.002] and CT-proET-1 [87 (76-95) vs. 60 (52-74) pmol L(-1); P < 0.001] were higher in patients with a peak VO(2) < 14 mL kg(-1) min(-1) (n = 30) than in those with a peak VO(2) > or = 14 mL kg(-1) min(-1) (n = 111). CT-pro-ET-1 had a higher area under the receiver-operator-characteristics curve (AUC) to predict a peak VO(2) < 14 mL kg(-1) min(-1) than BNP (0.79 vs. 0.68; P = 0.04). The optimal BNP cut-off of 37.2 pg mL(-1) had a sensitivity of 80% and a specificity of 56%. The optimal CT-proET-1 cut-off of 74.4 pmol L(-1) had a sensitivity of 80% and specificity of 76%. A five-item score composed of body mass index, diabetes, forced expiratory volume within the first second, alveolo-arterial oxygen pressure difference, and BNP had an AUC of 0.88 to predict a peak VO(2) < 14 mL kg(-1) min(-1). Adding CT-proET-1 to the score resulted in an AUC of 0.92.

CONCLUSIONS

C-terminal-pro-endothelin-1 is superior to BNP for the prediction of a peak VO(2) < 14 mL kg(-1) min(-1) in patients referred for CPET. A score incorporating body mass index, diabetes status, spirometry, blood gases, BNP and CT-proET-1 improves the prediction of a peak VO(2) < 14 mL kg(-1) min(-1) based on single biomarkers.

摘要

目的

评估B型利钠肽（BNP）和C末端前内皮素-1（CT-proET-1）对预测接受心肺运动试验患者严重受损的峰值耗氧量（峰值VO₂，<14 mL·kg⁻¹·min⁻¹）的效用。

设计

横断面研究。

地点

三级医疗中心。

方法

对141例连续接受心肺运动试验的患者评估峰值VO₂、BNP和CT-proET-1。

结果

峰值VO₂<14 mL·kg⁻¹·min⁻¹的患者（n = 30）的B型利钠肽[中位数（四分位间距）48（38 - 319）vs. 33（15 - 86）pg·mL⁻¹；P = 0.002]和CT-proET-1[87（76 - 95）vs. 60（52 - 74）pmol·L⁻¹；P < 0.001]高于峰值VO₂≥14 mL·kg⁻¹·min⁻¹的患者（n = 111）。CT-proET-1在预测峰值VO₂<14 mL·kg⁻¹·min⁻¹方面的受试者工作特征曲线下面积（AUC）高于BNP（0.79对0.68；P = 0.04）。BNP的最佳截断值为37.2 pg·mL⁻¹，灵敏度为80%，特异性为56%。CT-proET-1的最佳截断值为74.4 pmol·L⁻¹，灵敏度为80%，特异性为76%。由体重指数、糖尿病、第一秒用力呼气量、肺泡动脉氧分压差和BNP组成的五项评分预测峰值VO₂<14 mL·kg⁻¹·min⁻¹的AUC为0.88。将CT-proET-1加入该评分后AUC为0.92。