Berni Andrea, Cappelli Francesco, Bitossi Luca, Cecioni Ilaria, Cappelli Brunello, Toncelli Loira, Galanti Giorgio, Poggesi Loredana
Azienda Ospedaliero-Universitaria Careggi, Dipartimento di Area Critica Medico-Chirurgica, Università degli Studi di Firenze, Firenze, Italy.
Acta Cardiol. 2009 Apr;64(2):213-8. doi: 10.2143/AC.64.2.2036140.
The aim of the present study was to investigate whether the improvement of pulmonary capillary wedge pressure (PCWP) non-invasively assessed with tissue Doppler imaging is able to predict prognosis and cardiac-related mortality in patients with heart failure (HF), as previously demonstrated for NT-proBNP.
We prospectively studied 23 patients (74 +/- 10 y; 17 M, 6 F) with acute HF. NT-proBNP and PCWP were measured at admission and discharge. NT-proBNP concentrations were determined by a chemiluminescent immunoassay kit. PCWP was assessed using the ratio of transmitral E velocity to the early diastolic mitral annulus velocity (E'), with the formula PCWP = 1.9 + 1.24 (E/E'). Patients were divided in two groups according to the clinical end-point based on cardiac death and hospital readmission for HF.
After a mean follow-up of 230 days, 10 patients reached the end-point (group A), while 13 patients resulted event-free (group B). In group B, NT-proBNP values significantly decreased (3816 +/- 7424 vs. 6799 +/- 10537 pg/mL, P < 0.01) and PCWP improved (17 +/- 7 vs. 23 +/- 12 mmHg, P < 0.01). The decrease in both NT-proBNP and PCWP values was able to identify the majority of patients (77%) with an event-free survival at follow-up, whereas 70% of patients who reached the end-point had discordant changes in NT-proBNP and PCWP (chi2 = 5.06, P < 0.05).
The combination of a biochemical marker such as NT-proBNP and a new indicator of LV filling pressure (E/E') allows to estimate the prognostic impact of standard medical therapy even in a small group of HF patients.
本研究旨在探讨经组织多普勒成像无创评估的肺毛细血管楔压（PCWP）的改善是否能够像之前对N末端B型利钠肽原（NT-proBNP）所证明的那样，预测心力衰竭（HF）患者的预后和心脏相关死亡率。
我们对23例急性HF患者（74±10岁；男性17例，女性6例）进行了前瞻性研究。在入院时和出院时测量NT-proBNP和PCWP。NT-proBNP浓度通过化学发光免疫分析试剂盒测定。使用二尖瓣E峰速度与二尖瓣环舒张早期速度（E'）的比值评估PCWP，公式为PCWP = 1.9 + 1.24（E/E'）。根据基于心源性死亡和因HF再次入院的临床终点将患者分为两组。
平均随访230天后，10例患者达到终点（A组），而13例患者无事件发生（B组）。在B组中，NT-proBNP值显著降低（3816±7424 vs. 6799±10537 pg/mL，P < 0.01），PCWP改善（17±7 vs. 23±12 mmHg，P < 0.01）。NT-proBNP和PCWP值的降低能够识别大多数随访时无事件生存的患者（77%），而达到终点的患者中有70%在NT-proBNP和PCWP方面有不一致的变化（χ2 = 5.06，P < 0.05）。
诸如NT-proBNP这样的生化标志物与左心室充盈压的新指标（E/E'）相结合，即使在一小群HF患者中也能够评估标准药物治疗的预后影响。
