Sturgess D J, Parmar D, Dulhunty J M, Hedge R, Jarrett P, Udy A
Department of Intensive Care, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
Anaesth Intensive Care. 2013 Sep;41(5):591-5. doi: 10.1177/0310057X1304100503.
Left ventricular filling and thus diastolic function are frequently monitored and managed in critical care. However, scant data exist regarding possible screening tests for diastolic dysfunction in the intensive care unit (ICU). The present study aimed to evaluate plasma b-type natriuretic peptide (BNP) as a marker of diastolic dysfunction in a single-centre cohort of 'non-cardiac' ICU patients. The ICU is non-cardiac in that it provides mixed medical/surgical services with the exception of cardiology, cardiac surgery and solid organ transplantation. Clinical data were recorded over the first 24 hours of ICU stay for 32 consecutive patients. Transthoracic echocardiogram and blood collection for BNP assay were then performed. Diastolic dysfunction was demonstrated in 34% (n=11). Mean ± standard deviation BNP values were higher with diastolic dysfunction (238 ± 195 vs 72 ± 78 pg/ml; P=0.003). A BNP threshold of >43 pg/ml yielded a sensitivity of 80% and a specificity of 59%; area under the receiver operating characteristic curve was 0.82. BNP correlated independently with E/e' (R=0.425; P=0.015) (E/e': peak early transmitral velocity [E]/early diastolic mitral annular velocity [e']) but not left ventricular ejection fraction (P=0.8), illness severity (Acute Physiological and Chronic Health Evaluation II; P=0.3) or fluid balance (P=0.4). Diastolic dysfunction was common in this cohort of non-cardiac ICU patients and was independently associated with a significantly higher BNP. The potential application as a screening test for diastolic dysfunction is likely to require a threshold lower than previously proposed for heart failure.
在重症监护中，左心室充盈以及舒张功能常受到监测和管理。然而，关于重症监护病房（ICU）舒张功能障碍可能的筛查试验的数据却很少。本研究旨在评估血浆B型利钠肽（BNP）作为“非心脏”ICU患者单中心队列中舒张功能障碍标志物的情况。该ICU为非心脏专科，提供除心脏病学、心脏外科和实体器官移植外的综合医疗/外科服务。连续32例患者在入住ICU的头24小时内记录临床数据。然后进行经胸超声心动图检查并采集血样检测BNP。34%（n = 11）的患者存在舒张功能障碍。舒张功能障碍患者的平均±标准差BNP值更高（238±195 vs 72±78 pg/ml；P = 0.003）。BNP阈值>43 pg/ml时，敏感性为80%，特异性为59%；受试者工作特征曲线下面积为0.82。BNP与E/e'（R = 0.425；P = 0.015）（E/e'：二尖瓣早期峰值流速[E]/舒张早期二尖瓣环速度[e']）独立相关，但与左心室射血分数（P = 0.8）、疾病严重程度（急性生理与慢性健康状况评估II；P = 0.3）或液体平衡（P = 0.4）无关。在这个非心脏ICU患者队列中，舒张功能障碍很常见，且与显著更高的BNP独立相关。作为舒张功能障碍筛查试验的潜在应用可能需要低于先前针对心力衰竭提出的阈值。
