Area del Corazón. Hospitales Universitarios Virgen del Rocío. Sevilla. España.
Rev Esp Cardiol. 2010 Sep;63(9):1019-27. doi: 10.1016/s1885-5857(10)70205-x.
To assess the value of N-terminal fragment of brain natriuretic peptide (NT-proBNP) measurement and echocardiography for predicting ventricular remodeling after myocardial infarction and to investigate relationships between the NT-proBNP level and echocardiographic parameters at discharge and in the medium term.
The study involved 159 patients with myocardial infarction treated by primary coronary angioplasty. The NT-proBNP level was measured on admission, at discharge and after 6 months. Echocardiography was performed at discharge and after 6 months.
Overall, 31 patients (19.5%) demonstrated remodeling. At discharge, the variables associated with remodeling were: mitral inflow E-wave-to-A-wave velocity ratio (E/A), systolic mitral annulus velocity (Sm), early diastolic mitral annulus velocity (Em), the mitral inflow E wave to early diastolic mitral annulus velocity ratio (E/ Em), left atrial volume (LAV), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), and discharge NT-proBNP level. Only E/Em was an independent predictor of ventricular remodeling (odds ratio [OR]=1.143; 95% confidence interval [CI], 1.039-1.258; P=.006). At discharge, correlations were observed between the NT-proBNP level and LVEDV, LVESV, ejection fraction (EF) and E/Em. At 6 months, correlations with ventricular volumes and EF were unchanged, the correlation with E/Em was better (r=0.47 vs. r=0.69), and a modest correlation with LAV developed (r=0.43; P=.001).
The E/Em ratio was the best echocardiographic predictor of left ventricular remodeling after myocardial infarction. The NT-proBNP level had no additional predictive value over echocardiography. Correlations between the NT-proBNP level and ventricular volumes and EF at discharge and 6 months were similar, while correlations with E/Em and LAV were better at 6 months.
评估脑钠肽前体（NT-proBNP）测量和超声心动图在预测心肌梗死后心室重构中的价值，并探讨 NT-proBNP 水平与出院时和中期超声心动图参数之间的关系。
本研究纳入了 159 例接受直接冠状动脉成形术治疗的心肌梗死患者。在入院时、出院时和 6 个月时测量 NT-proBNP 水平。在出院时和 6 个月时进行超声心动图检查。
共有 31 例（19.5%）患者发生重构。出院时，与重构相关的变量包括：二尖瓣流入 E 波与 A 波速度比（E/A）、收缩期二尖瓣环速度（Sm）、舒张早期二尖瓣环速度（Em）、二尖瓣流入 E 波与舒张早期二尖瓣环速度比（E/Em）、左心房容积（LAV）、左心室收缩末期容积（LVESV）、左心室舒张末期容积（LVEDV）和出院时 NT-proBNP 水平。只有 E/Em 是心室重构的独立预测因子（比值比[OR]=1.143；95%置信区间[CI]，1.039-1.258；P=.006）。出院时，NT-proBNP 水平与 LVEDV、LVESV、射血分数（EF）和 E/Em 之间存在相关性。6 个月时，与心室容积和 EF 的相关性保持不变，与 E/Em 的相关性更好（r=0.47 比 r=0.69），与 LAV 的相关性略有增强（r=0.43；P=.001）。
E/Em 比值是心肌梗死后左心室重构的最佳超声心动图预测因子。NT-proBNP 水平对超声心动图无额外预测价值。出院时和 6 个月时 NT-proBNP 水平与心室容积和 EF 的相关性相似，而与 E/Em 和 LAV 的相关性在 6 个月时更好。
