CNR Institute of Clinical Physiology, Laboratory of Cardiovascular Biochemistry, Pisa, Italy.
Peptides. 2012 Aug;36(2):192-8. doi: 10.1016/j.peptides.2012.05.018. Epub 2012 Jun 5.
This study aimed to evaluate left ventricular assist device (LVAD) effects on natriuretic peptide (NP) prohormone plasma levels in end-stage heart failure (HF) patients, especially NT-proCNP, in order to better characterize the NP system during hemodynamic recovery by LVAD. HF patients (n=17, NYHA III-IV) undergoing LVAD were studied: 6 died of multi-organ failure syndrome (NS) and 11 survived (S). Total sequential organ failure assessment (t-SOFA) score and blood samples were obtained at admission (T1) and at 24, 72h and 1, 2, 4 weeks (T2-T6) after LVAD. In S, NT-proANP and NT-proCNP significantly increased at 24h after implantation, reaching a reduction to basal levels at 4 weeks following LVAD [NT-proANP: T1 vs. T2 p=0.017, NT-proCNP: T1 vs. T2 p=0.028, T1 vs. T3 p=0.043]. Elevated NT-proBNP plasma levels were observed at all times. In NS, NP plasma levels sustained higher with respect to S. No statistical variation was observed for NT-proCNP and NT-proANP in S and NS while NT-proBNP reached significant differences at T4 in NS. Considering S+NS, only NT-proCNP strongly correlated with t-SOFA score at T1 (rho=0.554, p=0.04) while subdividing patients NT-proCNP positively correlated in NS with t-SOFA score (rho=0.988, p=0.002) only at T4. In NS a correlation between NT-proCNP and NT-proBNP at T1 was observed (rho=-0.900, p=0.037). Both IL-6 and TNF-alpha sustained higher in NS patients than in S; in particular, statistical significance was observed for IL-6. The study of new peptides, such as NT-proCNP, would provide additional information for identifying patients who are more likely to recover.
本研究旨在评估左心室辅助装置 (LVAD) 对终末期心力衰竭 (HF) 患者利钠肽 (NP) 前体血浆水平的影响，特别是 NT-proCNP，以便更好地描述 LVAD 恢复血液动力学期间 NP 系统的特征。研究了 17 例接受 LVAD 的 HF 患者：6 例死于多器官衰竭综合征 (NS)，11 例存活 (S)。在 LVAD 后 24、72 小时和 1、2、4 周 (T2-T6)，分别获得总序贯器官衰竭评估 (t-SOFA) 评分和血液样本。在 S 中，NT-proANP 和 NT-proCNP 在植入后 24 小时明显增加，在 LVAD 后 4 周达到基础水平[NT-proANP：T1 与 T2 相比，p=0.017，NT-proCNP：T1 与 T2 相比，p=0.028，T1 与 T3 相比，p=0.043]。在所有时间点均观察到升高的 NT-proBNP 血浆水平。在 NS 中，NP 血浆水平与 S 相比持续升高。在 S 和 NS 中，NT-proCNP 和 NT-proANP 未观察到统计学差异，而 NT-proBNP 在 NS 中 T4 时达到显著差异。考虑到 S+NS，只有 NT-proCNP 在 T1 时与 t-SOFA 评分强烈相关(rho=0.554，p=0.04)，而在 NS 中 NT-proCNP 与 t-SOFA 评分在 T4 时呈正相关(rho=0.988，p=0.002)。在 NS 中，在 T1 时观察到 NT-proCNP 与 NT-proBNP 之间的相关性(rho=-0.900，p=0.037)。在 NS 患者中，IL-6 和 TNF-alpha 持续升高，而在 S 患者中未观察到统计学差异；特别是，IL-6 观察到统计学意义。对新肽，如 NT-proCNP 的研究将为识别更有可能恢复的患者提供额外信息。
