Mao Yi, Yang Yue-Jin, Zhang Jian, Ye Ling, Zhao Dong-Yun, Ni Xin-Hai, Chen Ji-Lin, Gao Run-Lin, Chen Zai-Jia
Depatment of Cardiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2009 Mar;37(3):218-22.
To explore the correlation between plasma BNP level and left ventricular dysfunction parameters in patients with acute myocardial infarction (AMI).
Plasma BNP level was determined in 230 consecutive inpatients with AMI and 111 normal controls. Patients were grouped according Killip grades, LVEF and LVEDd, respectively. BNP was transformed into lnBNP for the normal distribution. The receiver operator characteristic curve (ROC curve) was drawn to determine the best threshold and criteria for diagnosing heart failure.
After AMI, lnBNP levels increased significantly in proportion with increasing Killip grades (I-III), and decreasing LVEF (all P < 0.05). lnBNP level was significantly higher in LVEDd > 55 mm group than in the LVEDd < 55 mm group (P < 0.01). lnBNP, LVEDd and LVEF all linearly correlated with Killip grades (P < 0.05) and the best correlation was shown between lnBNP and Killip grades (r = 0.53, P < 0.05). lnBNP also positively correlated with LVEDd (r = 0.17, P < 0.05) and negatively correlated with LVEF (r = -0.41, P < 0.01). Among the parameters, lnBNP level presented the largest AUC in their ROC curves (P < 0.01) for diagnosing decompensated heart failure and cardiogenic shock. The sensitivity, specifiticity and accuracy rates for diagnosing decompensated heart failure were 84.9%, 45.0% and 70.0% respectively by lnBNP at the cut point of 140 ng/L. The sensitivity, negative predicting value and accuracy rate for diagnosing cardiac shock were 82.8%, 66.7% and 67.4% respectively by BNP at the cut point of 400 ng/L.
lnBNP level in hospitalized patients with AMI was positively correlated with Killip grades and LVEDd, negatively correlated with LVEF and could serve as a parameter for diagnosing the decompensated heart failure and excluding the cardiac shock.
探讨急性心肌梗死（AMI）患者血浆脑钠肽（BNP）水平与左心室功能障碍参数之间的相关性。
测定230例连续住院的AMI患者及111例正常对照者的血浆BNP水平。患者分别根据Killip分级、左心室射血分数（LVEF）和左心室舒张末期内径（LVEDd）进行分组。将BNP转换为lnBNP以使其呈正态分布。绘制受试者工作特征曲线（ROC曲线）以确定诊断心力衰竭的最佳阈值和标准。
AMI后，lnBNP水平随Killip分级升高（I - III级）及LVEF降低而显著升高（均P < 0.05）。LVEDd > 55 mm组的lnBNP水平显著高于LVEDd < 55 mm组（P < 0.01）。lnBNP、LVEDd和LVEF均与Killip分级呈线性相关（P < 0.05），且lnBNP与Killip分级的相关性最佳（r = 0.53，P < 0.05）。lnBNP也与LVEDd呈正相关（r = 0.17，P < 0.05），与LVEF呈负相关（r = -0.41，P < 0.01）。在这些参数中，lnBNP水平在其ROC曲线中诊断失代偿性心力衰竭和心源性休克时呈现最大的曲线下面积（AUC）（P < 0.01）。lnBNP在切点为140 ng/L时诊断失代偿性心力衰竭的敏感性、特异性和准确率分别为84.9%、45.0%和70.0%。BNP在切点为400 ng/L时诊断心源性休克的敏感性、阴性预测值和准确率分别为82.8%、66.7%和67.4%。
AMI住院患者的lnBNP水平与Killip分级和LVEDd呈正相关，与LVEF呈负相关，可作为诊断失代偿性心力衰竭和排除心源性休克的一个参数。
