Kilickesmez Kadriye Orta, Ozkan Alev Arat, Abaci Okay, Camlıca Hakan, Kocas Cuneyt, Kaya Aysem, Baskurt Murat, Yiğit Zerrin, Kucukoğlu Serdar
Department of Cardiology, Istanbul University Institute of Cardiology, Istanbul, Turkey.
Echocardiography. 2011 Jan;28(1):8-14. doi: 10.1111/j.1540-8175.2010.01273.x. Epub 2010 Aug 24.
To determine whether elevated N-terminal pro-BNP (NT pro-BNP) predicts pulmonary artery systolic pressure increase on exercise stress echocardiography in asymptomatic or mildly symptomatic patients with moderate to severe mitral stenosis.
Forty-one asymptomatic or mildly symptomatic patients with moderate to severe mitral stenosis and 21 age- and sex-matched healthy subjects. Transthoracic echocardiography was performed in all patients to assess the severity of the valve disease and to measure pulmonary artery pressure before and immediately after treadmill exercise. Blood samples for NT pro-BNP were also collected before and immediately after treadmill exercise at the time of echocardiographic examination. The plasma concentrations of NT pro-BNP levels were significantly higher in patients with mitral stenosis than in control subjects before and after exercise (P < 0.001). Patients with atrial fibrillation had significantly higher NT pro-BNP levels compared to those with sinus rhythm (P < 0.001). Pre- and postexercise NT pro-BNP levels correlated statistically significantly with the left atrial (LA) dimension, right ventricle enddiastolic diameter, exercise duration, heart rate, rest, and exercise pulmonary artery systolic pressure, after exercise mitral valve mean gradient. Area under the receiver-operating characteristic curve for NT pro-BNP as an exercise induced augmentation of pulmonary artery pressure was 0.78. Using an optimized cutoff value of 251 pg/mL for NT pro-BNP, sensitivity was 89.47%. The independent determinants of higher pulmonary artery pressure were LA diameter and pretest NT pro-BNP levels in multivariante analysis.
NT pro-BNP levels correlate with functional class and echocardiographic findings in patients with mitral stenosis and indicate exercise induced augmentation of peak PAP > 60 mmHg. (Echocardiography 2011;28:8-14).
确定在无症状或症状轻微的中重度二尖瓣狭窄患者中，N末端B型利钠肽原（NT pro-BNP）升高是否能预测运动负荷超声心动图检查时肺动脉收缩压的升高。
41例无症状或症状轻微的中重度二尖瓣狭窄患者以及21例年龄和性别匹配的健康受试者。对所有患者进行经胸超声心动图检查，以评估瓣膜疾病的严重程度，并测量跑步机运动前及运动后即刻的肺动脉压力。在超声心动图检查时，还在跑步机运动前及运动后即刻采集NT pro-BNP的血样。二尖瓣狭窄患者运动前后血浆NT pro-BNP水平均显著高于对照组（P<0.001）。与窦性心律患者相比，房颤患者的NT pro-BNP水平显著更高（P<0.001）。运动前后NT pro-BNP水平与左心房（LA）内径、右心室舒张末期内径、运动持续时间、心率、静息及运动后肺动脉收缩压、运动后二尖瓣平均压差在统计学上显著相关。NT pro-BNP作为运动诱导的肺动脉压力升高的受试者操作特征曲线下面积为0.78。使用NT pro-BNP的优化临界值251 pg/mL，敏感性为89.47%。在多变量分析中，肺动脉压力升高的独立决定因素是LA直径和检测前NT pro-BNP水平。
二尖瓣狭窄患者的NT pro-BNP水平与功能分级及超声心动图结果相关，并提示运动诱导的肺动脉峰值压升高>60 mmHg。（《超声心动图》2011年；28:8 - 14）
