Mitchell Adam, Misialek Jeffrey R, Folsom Aaron R, Duprez Daniel, Alonso Alvaro, Jerosch-Herold Michael, Sanchez Otto A, Watson Karol E, Sallam Tamer, Konety Suma H
Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Division of Epidemiology and Community Health School of Public Health, University of Minnesota, Minneapolis, Minnesota.
Am J Cardiol. 2015 May 15;115(10):1341-5. doi: 10.1016/j.amjcard.2015.02.040. Epub 2015 Feb 18.
This study sought to investigate the relation between myocardial perfusion and N-terminal pro-brain natriuretic peptide (NT-proBNP) in asymptomatic adults without overt coronary artery disease. NT-proBNP is a cardiac neurohormone secreted from the ventricles in response to ventricular volume expansion and pressure overload and may also be elevated in the setting of reduced myocardial perfusion. We hypothesized that reduced myocardial perfusion reserve (MPR) would be associated with elevated NT-proBNP in participants free of overt cardiovascular disease. MPR was measured by cardiac magnetic resonance, before and after adenosine infusion, in 184 MESA participants (mean age 60 ± 10.4, 58% white, 42% Hispanic, 44% women) without overt cardiovascular disease. MPR was modeled as hyperemic myocardial blood flow (MBF) adjusted for MBF at rest. A linear regression analysis, adjusted for demographics, established cardiovascular risk factors, left ventricular mass, coronary calcium score, body mass index, and medications, was used to determine the association between MPR and NT-proBNP. Participants with low hyperemic MBF were more likely to be older, male, diabetic, and have higher blood pressure and higher coronary artery calcium score. Mean hyperemic MBF was 3.04 ± 0.829 ml/min/g. MPR was inversely associated with NT-proBNP levels. In a fully adjusted model, every 1-SD decrement in MPR was associated with a 21% increment in NT-proBNP (p = 0.04). In conclusion, MPR is inversely associated with NT-proBNP level in this cross-sectional study of asymptomatic adults free of overt coronary artery disease, suggesting that higher NT-proBNP levels may reflect subclinical myocardial microvascular dysfunction.
本研究旨在调查无明显冠状动脉疾病的无症状成年人的心肌灌注与N末端脑钠肽前体（NT-proBNP）之间的关系。NT-proBNP是一种心脏神经激素，由心室分泌，以应对心室容量扩张和压力过载，在心肌灌注减少的情况下也可能升高。我们假设，在无明显心血管疾病的参与者中，心肌灌注储备（MPR）降低与NT-proBNP升高有关。通过心脏磁共振测量了184名无明显心血管疾病的多族裔动脉粥样硬化研究（MESA）参与者（平均年龄60±10.4岁，58%为白人，42%为西班牙裔，44%为女性）在静脉注射腺苷前后的MPR。MPR被建模为静息心肌血流量（MBF）校正后的充血心肌血流量。采用线性回归分析，对人口统计学、既定心血管危险因素、左心室质量、冠状动脉钙化评分、体重指数和药物进行校正，以确定MPR与NT-proBNP之间的关联。充血性MBF较低的参与者更可能年龄较大、为男性、患有糖尿病且血压较高、冠状动脉钙化评分较高。平均充血性MBF为3.04±0.829 ml/min/g。MPR与NT-proBNP水平呈负相关。在一个完全校正的模型中，MPR每降低1个标准差与NT-proBNP升高21%相关（p = 0.04）。总之，在这项针对无明显冠状动脉疾病的无症状成年人的横断面研究中，MPR与NT-proBNP水平呈负相关，表明较高的NT-proBNP水平可能反映亚临床心肌微血管功能障碍。
