Tripepi Giovanni, Mattace-Raso Francesco, Mallamaci Francesca, Benedetto Francesco Antonio, Witteman Jacqueline, Malatino Lorenzo, Zoccali Carmine
CNR-IBIM, Istituto di Biomedicina, Epidemiologia Clinica e Fisiopatologia, delle Malattie Renali e dell'Ipertensione Arteriosa, c/o Euroline di Ascrizzi Vincenzo, via Vallone Petrara 55-57, Reggio Calabria, Italy.
Hypertension. 2009 Oct;54(4):818-24. doi: 10.1161/HYPERTENSIONAHA.109.136804. Epub 2009 Jul 27.
Left atrial volume (LAV) has recently emerged as a useful biomarker for risk stratification and risk monitoring in patients with end stage renal disease. We investigated the relationship between cardiac natriuretic peptides (atrial natriuretic peptide [ANP] and brain natriuretic peptide [BNP]) and norepinephrine (NE) with LAV and LAV changes over time in 199 end stage renal disease patients. At baseline, LAV was directly related to BNP (r=0.60), ANP (r=0.59), and NE (r=0.28; P<0.001), and these relationships held true in multiple-regression models adjusting for potential confounders (P< or =0.003). In the longitudinal study (17+/-2 months), LAV increased from 9.8+/-4.6 to 10.9+/-5.4 mL/m(2.7) (+11%). In a multiple linear regression model, BNP (beta=0.28; P=0.003), ANP (beta=0.22; P=0.03), and NE (beta=0.27; P=0.003) predicted LAV changes. The area under the receiver operating characteristic curve for predicting LAV changes (>3 mL/m(2.7) per year) of a risk score on the basis of standard risk factors was 0.72. Plasma BNP (+12%; P=0.004), ANP (+8%; P=0.03), NE (+8%; P=0.05) and midwall fraction shortening (+8%; P=0.05) increased the area under the receiver operating characteristic curve to a significant extent, whereas LV mass did not (+5%; P=0.18). Predictive models, including BNP, ANP, and NE, maintained a satisfactory discriminatory power for LAV and LAV changes also when tested by a bootstrap resampling technique. BNP and ANP are strongly related to LAV in the end stage renal disease patients and predict LAV changes over time in these patients. Because an increased LAV underlies diastolic dysfunction and/or volume overload (ie, potentially modifiable risk factors), the measurement of the plasma concentration of these compounds might be useful for risk stratification and for guiding treatment in dialysis patients.
左心房容积（LAV）最近已成为终末期肾病患者风险分层和风险监测的一种有用生物标志物。我们研究了199例终末期肾病患者中心脏利钠肽（心房利钠肽[ANP]和脑利钠肽[BNP]）以及去甲肾上腺素（NE）与LAV及其随时间变化之间的关系。在基线时，LAV与BNP（r = 0.60）、ANP（r = 0.59）和NE（r = 0.28；P < 0.001）直接相关，并且在调整了潜在混杂因素的多元回归模型中这些关系依然成立（P ≤ 0.003）。在纵向研究（17 ± 2个月）中，LAV从9.8 ± 4.6增加至10.9 ± 5.4 mL/m(2.7)（增加了11%）。在多元线性回归模型中，BNP（β = 0.28；P = 0.003）、ANP（β = 0.22；P = 0.03）和NE（β = 0.27；P = 0.003）可预测LAV的变化。基于标准风险因素的风险评分预测LAV变化（每年>3 mL/m(2.7)）的受试者工作特征曲线下面积为0.72。血浆BNP（增加12%；P = 0.004）、ANP（增加8%；P = 0.03）、NE（增加8%；P = 0.05）和室壁中层缩短率（增加8%；P = 0.05）在很大程度上增加了受试者工作特征曲线下面积，而左心室质量则未增加（增加5%；P = 0.18）。当通过自助重抽样技术进行测试时，包括BNP、ANP和NE的预测模型对LAV及其变化也保持了令人满意的辨别能力。在终末期肾病患者中，BNP和ANP与LAV密切相关，并可预测这些患者LAV随时间的变化。由于LAV增加是舒张功能障碍和/或容量超负荷（即潜在可改变的风险因素）的基础，测量这些化合物的血浆浓度可能有助于透析患者的风险分层和指导治疗。
