Department of Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, The Netherlands.
Thromb Haemost. 2012 Aug;108(2):367-72. doi: 10.1160/TH11-12-0901. Epub 2012 Jun 28.
N-terminal pro-Brain Natriuretic Peptide (NT-pro-BNP) is primarily secreted by left ventricular (LV) stretch and wall tension. Notably, NT-pro-BNP is a prognostic marker in acute pulmonary embolism (PE), which primarily stresses the right ventricle (RV). We sought to evaluate the relative contribution of the RV to NT-pro-BNP levels during PE. A post-hoc analysis of an observational prospective outcome study in 113 consecutive patients with computed tomography (CT)-proven PE and 226 patients in whom PE was clinically suspected but ruled out by CT. In all patients RV and LV function was established by assessing ECG-triggered-CT measured ventricular end-diastolic-volumes and ejection fraction (EF). NT-pro-BNP was assessed in all patients. The correlation between RV and LV end-diastolic-volumes and systolic function was evaluated by multiple linear regression corrected for known confounders. In the PE cohort increased RVEF (β-coefficient (95% confidence interval [CI]) -0.044 (± -0.011); p<0.001) and higher RV end-diastolic-volume (β-coefficient 0.005 (± 0.001); p<0.001) were significantly correlated to NT-pro-BNP, while no correlation was found with LVEF (β-coefficient 0.005 (± 0.010); p=0.587) and LV end-diastolic-volume (β-coefficient -0.003 (± 0.002); p=0.074). In control patients without PE we found a strong correlation between NT-pro-BNP levels and LVEF (β-coefficient -0.027 (± -0.006); p<0.001) although not LV end-diastolic-volume (β-coefficient 0.001 (± 0.001); p=0.418). RVEF (β-coefficient -0.002 (± -0.006); p=0.802) and RV end-diastolic-volume (β-coefficient <0.001 (± 0.001); p=0.730) were not correlated in patients without PE. In PE patients, lower RVEF and higher RV end-diastolic-volume were significantly correlated to NT-pro-BNP levels as compared to control patients without PE. These observations provide pathophysiological ground for the well-known prognostic value of NT-pro-BNP in acute PE.
N-末端脑利钠肽前体（NT-pro-BNP）主要由左心室（LV）拉伸和壁张力分泌。值得注意的是，NT-pro-BNP 是急性肺栓塞（PE）的预后标志物，主要强调右心室（RV）。我们试图评估 RV 在 PE 期间对 NT-pro-BNP 水平的相对贡献。对 113 例连续经计算机断层扫描（CT）证实的 PE 患者和 226 例经 CT 排除但临床怀疑为 PE 的患者的前瞻性观察结局研究进行了事后分析。在所有患者中，通过评估心电图触发的 CT 测量的心室舒张末期容积和射血分数（EF）来确定 RV 和 LV 功能。所有患者均评估 NT-pro-BNP。通过多元线性回归校正已知混杂因素，评估 RV 和 LV 舒张末期容积和收缩功能之间的相关性。在 PE 队列中，RVEF 增加（β系数（95%置信区间[CI]）-0.044（±-0.011）；p<0.001）和 RV 舒张末期容积升高（β系数 0.005（±0.001）；p<0.001）与 NT-pro-BNP 显著相关，而与 LVEF 无相关性（β系数 0.005（±0.010）；p=0.587）和 LV 舒张末期容积（β系数-0.003（±0.002）；p=0.074）。在没有 PE 的对照组患者中，我们发现 NT-pro-BNP 水平与 LVEF 之间存在很强的相关性（β系数-0.027（±-0.006）；p<0.001），尽管与 LV 舒张末期容积无相关性（β系数 0.001（±0.001）；p=0.418）。在没有 PE 的患者中，RVEF（β系数-0.002（±-0.006）；p=0.802）和 RV 舒张末期容积（β系数<0.001（±0.001）；p=0.730）与 NT-pro-BNP 无关。与没有 PE 的对照组患者相比，PE 患者的较低 RVEF 和较高的 RV 舒张末期容积与 NT-pro-BNP 水平显著相关。这些观察结果为 NT-pro-BNP 在急性 PE 中的已知预后价值提供了病理生理学基础。
