Ahmanson/UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Am J Cardiol. 2012 Nov 15;110(10):1523-6. doi: 10.1016/j.amjcard.2012.06.061. Epub 2012 Aug 3.
The aim of this study was to evaluate the prognostic value of brain natriuretic peptide (BNP) in outpatients with the Eisenmenger syndrome (ES). BNP is often elevated in patients with cyanotic congenital heart disease. The clinical utility of BNP in patients with cyanotic congenital heart disease and the ES has not been clearly delineated. Records of adults with ES who had undergone serum BNP measurement were reviewed. The primary end point was death or heart failure admission. Fifty-three patients were included, with 15 patients (28%) meeting the primary end point (death in 7, heart failure hospitalization in 8). Mean and median baseline BNP in patients meeting the primary end point were 322 ± 346 and 179 pg/ml, compared to 100 ± 157 and 41 pg/ml in those not meeting the primary end point (p = 0.0029). A Cox proportional-hazards model using baseline BNP between the 2 groups yielded a hazard ratio of 1.84 (95% confidence interval [CI] 1.19 to 2.85, p = 0.006). The relative risk for baseline BNP level >140 pg/ml was 4.62 (95% CI 1.80 to 11.3, p = 0.008). Patients who met the primary end point increased their BNP levels by 42.5 pg/ml per year (95% CI 12.09 to 72.95, p = 0.006) compared to 7.2 pg/ml per year (95% CI 2.01 to 12.47, p = 0.007) in patients who did not meet the primary end point. In conclusion, elevated BNP levels are predictive of death or heart failure admission in patients with the ES. A serum BNP level >140 pg/ml is a useful tool in identifying high-risk patients.
本研究旨在评估脑钠肽（BNP）在艾森曼格综合征（ES）门诊患者中的预后价值。 BNP 在紫绀性先天性心脏病患者中常升高。 BNP 在紫绀性先天性心脏病和 ES 患者中的临床应用尚未明确界定。 回顾了接受血清 BNP 测量的 ES 成人的记录。 主要终点是死亡或心力衰竭入院。 共纳入 53 例患者，其中 15 例（28%）达到主要终点（死亡 7 例，心力衰竭住院 8 例）。 达到主要终点的患者的平均和中位数基线 BNP 分别为 322±346 和 179pg/ml，而未达到主要终点的患者分别为 100±157 和 41pg/ml（p=0.0029）。 使用两组之间的基线 BNP 的 Cox 比例风险模型得出风险比为 1.84（95%置信区间[CI] 1.19 至 2.85，p=0.006）。 基线 BNP 水平>140pg/ml 的相对风险为 4.62（95%CI 1.80 至 11.3，p=0.008）。 达到主要终点的患者每年 BNP 水平增加 42.5pg/ml（95%CI 12.09 至 72.95，p=0.006），而未达到主要终点的患者每年增加 7.2pg/ml（95%CI 2.01 至 12.47，p=0.007）。 总之，升高的 BNP 水平可预测 ES 患者的死亡或心力衰竭入院。 BNP 水平>140pg/ml 是识别高危患者的有用工具。
