Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
J Cardiovasc Med (Hagerstown). 2012 Jun;13(6):360-7. doi: 10.2459/JCM.0b013e328353128c.
B-type natriuretic peptide (BNP) levels provide diagnostic and prognostic information in heart failure. This study determined the frequency of BNP assessment and analyzed demographic characteristics, clinical variables and the utilization of guideline-recommended heart failure therapies by BNP level in outpatients with reduced left ventricular ejection fraction (LVEF).
The IMPROVE HF registry (The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting) is a prospective cohort study of patients at least 18 years of age with a LVEF 35% or less and chronic heart failure or previous myocardial infarction (MI) presenting to cardiology and multispecialty practices. The medical records of 15,381 patients were reviewed. BNP was measured in 4213 (27.4%) patients and the median plasma BNP level was 384 pg/ml (interquartile range 158-877 pg/ml). Patients were stratified by plasma BNP measurements into the following tertiles: 219 pg/ml or less, more than 219 to 649 pg/ml, and more than 649 pg/ml. Jugular venous distension, pedal edema, rales and systolic murmur on physical examination and elevated renal function parameters were associated with higher BNP levels. BNP assessment and elevated BNP levels were not associated with greater use of any of the quality of care measures. However, patients with a BNP in the top tertile were less likely to be treated with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers or aldosterone antagonists compared with patients with a BNP in the bottom tertile.
Among practices participating in IMPROVE HF, BNP was not measured in most outpatients with reduced LVEF and chronic heart failure or previous MI. BNP assessment or the BNP level in patients with recorded measurements, with few exceptions, did not impact the utilization of guideline-recommended therapies.
B 型利钠肽（BNP）水平为心力衰竭提供了诊断和预后信息。本研究旨在确定门诊射血分数降低的心力衰竭患者（LVEF）中 BNP 评估的频率，并分析按 BNP 水平分层的人口统计学特征、临床变量和指南推荐的心力衰竭治疗方法的应用情况。
改善 HF 登记处（旨在改善门诊环境下基于证据的心力衰竭治疗方法应用的登记处）是一项前瞻性队列研究，共纳入 15381 例年龄至少 18 岁、LVEF 35%或更低、患有慢性心力衰竭或既往心肌梗死（MI）的患者，这些患者来自心脏病学和多专科诊所。对这些患者的病历进行了回顾性分析。共对 4213 例（27.4%）患者进行了 BNP 测量，其血浆 BNP 中位数为 384pg/ml（四分位间距 158-877pg/ml）。患者按 BNP 测量值分为以下三分位：219pg/ml 或更低、219-649pg/ml 和 649pg/ml 以上。体格检查时颈静脉扩张、足踝水肿、啰音和收缩期杂音以及肾功能参数升高与 BNP 水平升高相关。BNP 评估和 BNP 水平升高与任何一项护理质量措施的应用均无相关性。然而，与 BNP 处于最低三分位的患者相比，BNP 处于最高三分位的患者接受血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂或醛固酮拮抗剂治疗的可能性更低。
在参与改善 HF 登记处的实践中，大多数 LVEF 降低且患有慢性心力衰竭或既往 MI 的门诊患者并未测量 BNP。除了少数例外情况，BNP 评估或记录 BNP 测量值的患者并未影响指南推荐的治疗方法的应用。
