Division of Cardiovascular Medicine, Vanderbilt Medical Center, Vanderbilt University, Nashville, Tennessee, USA.
Pulm Circ. 2013 Apr;3(2):345-9. doi: 10.4103/2045-8932.114762.
Intracardiac and transpulmonary levels of natriuretic peptides (NPs) and cyclic guanosine monophosphate (cGMP) provide insight into the pathophysiology of pulmonary hypertension (PH) secondary to left-heart failure but have not been evaluated in established or suspected pulmonary arterial hypertension (PAH). Demonstrating adequate reproducibility of these markers is an important precursor to further study. We hypothesized that the reproducibility of intracardiac and transpulmonary NPs and cGMP is similar to the reproducibility of these markers sampled from the peripheral venous circulation. In outpatients undergoing right-heart catheterization for PH, blood samples were obtained from a peripheral venous site, superior vena cava, inferior vena cava, coronary sinus, pulmonary artery, and pulmonary capillary wedge position. At each site, a repeat sample was collected approximately 60 seconds after the initial measurement. Reproducibility was assessed using the slope of the regression line between initial and follow-up levels. We enrolled 10 patients: Six had PAH, two had pulmonary venous hypertension, and two had normal pulmonary pressure. At all sites, the slopes of the regression lines for BNP were close to identity. BNP was generally more reproducible than NT-pro-BNP. For the NPs and cGMP, reproducibility at intracardiac and transpulmonary sites was similar to the peripheral venous site. Reproducibility of NPs was not influenced by PH severity, access site, or time between measurements. The two patients with the highest transpulmonary pressure gradients had high transpulmonary BNP uptake, but their transpulmonary cGMP gradients were negative. In patients evaluated for PH, reproducibility of NPs and cGMP at intracardiac and transpulmonary sites is high and is comparable to that of peripheral venous measurements.
心内和肺内的利钠肽（NPs）和环鸟苷酸（cGMP）水平提供了对左心衰竭引起的肺动脉高压（PH）的病理生理学的深入了解，但尚未在已建立或疑似肺动脉高压（PAH）中进行评估。证明这些标志物具有足够的可重复性是进一步研究的重要前提。我们假设，心内和肺内 NPs 和 cGMP 的可重复性与从外周静脉循环中采样的这些标志物的可重复性相似。在因 PH 接受右心导管检查的门诊患者中，从外周静脉、上腔静脉、下腔静脉、冠状窦、肺动脉和肺动脉楔压部位采集血液样本。在每个部位，在初始测量后约 60 秒采集重复样本。使用初始和随访水平之间回归线的斜率来评估可重复性。我们纳入了 10 名患者：6 名患有 PAH，2 名患有肺静脉高压，2 名患有正常肺压。在所有部位，BNP 的回归线斜率都接近一致。BNP 通常比 NT-pro-BNP 更具可重复性。对于 NPs 和 cGMP，心内和肺内部位的可重复性与外周静脉部位相似。NPs 的可重复性不受 PH 严重程度、进入部位或两次测量之间的时间影响。两个跨肺压力梯度最高的患者具有较高的跨肺 BNP 摄取，但他们的跨肺 cGMP 梯度为负值。在评估 PH 的患者中，心内和肺内 NPs 和 cGMP 的可重复性很高，与外周静脉测量的可重复性相当。
