Instituto do Coração, FMUSP, São Paulo, SP, Brazil.
Arq Bras Cardiol. 2013 Mar;100(3):281-7. doi: 10.5935/abc.20130066.
Heart failure (HF) is a condition with poor outcome, especially in advanced cases. Determination of B-type natriuretic peptide (BNP) levels is useful in the diagnosis of cardiac decompensation and has also been proving useful in the prognostic evaluation.
To verify whether BNP levels are able to identify patients with a poorer outcome and whether it is an independent prognostic factor considering age, gender, cardiac and renal functions, as well as the cause of heart disease.
189 patients in functional class III/IV advanced HF were studied. All had systolic dysfunction and had their BNP levels determined during hospitalization. Variables related to mortality were studied using univariate and multivariate analyses.
BNP levels were higher in patients who died in the first year of follow-up (1,861.9 versus 1,408.1 pg/dL; p = 0.044) and in chagasic patients (1,985 versus 1,452 pg/mL; p = 0.001); the latter had a higher mortality rate in the first year of follow-up (56% versus 35%; p = 0.010). The ROC curve analysis showed that the BNP level of 1,400 pg/mL was the best predictor of events; high levels were associated with lower LVEF (0.23 versus 0.28; p = 0.002) and more severe degree of renal dysfunction (mean urea 92 versus 74.5 mg/dL; p = 0.002).
In advanced HF, high BNP levels identified patients at higher risk of a poorer outcome. Chagasic patients showed higher BNP levels than those with heart diseases of other causes, and have poorer prognosis.
心力衰竭（HF）是一种预后不良的疾病，尤其是在晚期病例中。B 型利钠肽（BNP）水平的测定对心脏失代偿的诊断很有用，在预后评估中也被证明是有用的。
验证 BNP 水平是否能够识别预后较差的患者，以及它是否是一个独立的预后因素，考虑年龄、性别、心脏和肾功能以及心脏病的病因。
研究了 189 例功能分级 III/IV 级晚期 HF 患者。所有患者均有收缩功能障碍，并在住院期间测定了 BNP 水平。使用单变量和多变量分析研究了与死亡率相关的变量。
在随访的第一年死亡的患者中，BNP 水平更高（1,861.9 与 1,408.1 pg/dL；p = 0.044），且在恰加斯病患者中更高（1,985 与 1,452 pg/mL；p = 0.001）；后者在随访的第一年死亡率更高（56%与 35%；p = 0.010）。ROC 曲线分析表明，BNP 水平 1,400 pg/mL 是事件的最佳预测指标；高水平与较低的 LVEF（0.23 与 0.28；p = 0.002）和更严重的肾功能障碍（平均尿素 92 与 74.5 mg/dL；p = 0.002）相关。
在晚期 HF 中，高 BNP 水平可识别预后较差的患者风险较高。恰加斯病患者的 BNP 水平高于其他病因的心脏病患者，预后较差。
