Second Department of Cardiology, Attikon Hospital, Medical School, University of Athens, Athens, Greece.
Shock. 2010 Feb;33(2):141-8. doi: 10.1097/SHK.0b013e3181ad31f8.
The mechanisms of the N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) release in intensive care unit (ICU) patients with preserved ejection fraction (EF) are unclear. We investigated whether left ventricular (LV) dysfunction, as assessed by tissue Doppler imaging (TDI), is related to NT-pro-BNP levels in ICU patients with preserved EF and has a complementary value to NT-pro-BNP in the determination of in-hospital mortality. We examined 58 mechanically ventilated patients with no history of heart failure (age, 60 +/- 18 years; EF, 63% +/- 7%). The systolic (S) and early diastolic (E') velocity of the mitral annulus by TDI and the E/E' as well as NT-pro-BNP, troponin, lactate acid, blood oxygen (P(O2)/Fi(O2)), sepsis, and ICU mortality were assessed. Systolic, E', and E/E' correlated with age, P(O2)/Fi(O2), lactate acid, NT-pro-BNP, troponin, history of arterial hypertension, and diabetes (P < 0.05). By multivariate analysis, the determinants of NT-pro-BNP were S (P = 0.024), E/E' (P = 0.017), and sepsis (P = 0.015). An NT-pro-BNP greater than 941 pg/mL was a reliable predictor of LV diastolic dysfunction defined as a composite of E' less than or equal to 8 cm/s and/or mean E/E greater than or equal to 13 (area under the curve, 75%; P = 0.03). Patients with combined NT-pro-BNP greater than 941 pg/mL and abnormal TDI markers had increased creatinine levels and a lower MAP, P(O2)/Fi(O2), and survival rate than those with abnormal TDI or NT-pro-BNP alone or patients with normal TDI markers and NT-pro-BNP (25%, 60%, 70%, and 84%, respectively; P < 0.05). The addition of abnormal TDI in a model including NT-pro-BNP and sepsis increased the model's value for in-hospital mortality (P for change = 0.01). In ICU patients with preserved EF, LV diastolic dysfunction and sepsis determine NT-pro-BNP levels. Tissue Doppler imaging markers and NT-pro-BNP have a complementary value for in-hospital mortality.
在射血分数保留的重症监护病房（ICU）患者中，N 端脑利钠肽前体（NT-pro-BNP）释放的机制尚不清楚。我们研究了组织多普勒成像（TDI）评估的左心室（LV）功能障碍是否与射血分数保留的 ICU 患者的 NT-pro-BNP 水平相关，并在确定住院死亡率方面是否具有与 NT-pro-BNP 互补的价值。我们检查了 58 例无心力衰竭史的机械通气患者（年龄 60±18 岁；EF 63%±7%）。通过 TDI 评估二尖瓣环的收缩（S）和早期舒张（E'）速度以及 E/E'和 NT-pro-BNP、肌钙蛋白、乳酸、血氧（P（O2）/Fi（O2））、败血症和 ICU 死亡率。S、E'和 E/E'与年龄、P（O2）/Fi（O2）、乳酸、NT-pro-BNP、肌钙蛋白、高血压病史和糖尿病相关（P<0.05）。多元分析显示，NT-pro-BNP 的决定因素为 S（P=0.024）、E/E'（P=0.017）和败血症（P=0.015）。NT-pro-BNP 大于 941pg/mL 是 LV 舒张功能障碍的可靠预测因子，定义为 E'小于或等于 8cm/s 和/或平均 E/E 大于或等于 13（曲线下面积为 75%；P=0.03）。与 TDI 标志物异常或 NT-pro-BNP 单独异常或 TDI 标志物正常和 NT-pro-BNP 正常的患者相比，NT-pro-BNP 大于 941pg/mL 且 TDI 标志物异常的患者血肌酐水平升高，MAP、P（O2）/Fi（O2）和存活率较低（分别为 25%、60%、70%和 84%；P<0.05）。在包括 NT-pro-BNP 和败血症的模型中加入 TDI 异常增加了模型对住院死亡率的预测价值（P 变化=0.01）。在射血分数保留的 ICU 患者中，LV 舒张功能障碍和败血症决定了 NT-pro-BNP 水平。组织多普勒成像标志物和 NT-pro-BNP 在预测住院死亡率方面具有互补价值。
