Teplyakov A T, Pyshnikova E Yu, Andriyanova A V, Kalyuzhin V V, Suslova T E, Nikonova E N, Karpov R S
Research Institute for Cardiology, Tomsk, Russia.
Kardiologiia. 2016 Apr;56(4):42-48. doi: 10.18565/cardio.2016.4.42-48.
To study diagnostic value of myocardial-arterial stiffness (MAS) as a determinant of N-terminal pro-brain natriuretic peptide (NT-proBNP) expression in patients with chronic heart failure (CHF) with ischemic or postinfarction left ventricular (LV) dysfunction.
We analyzed 6 months prognosis of 54 patients (mean age 61.7+/-8.6 years) with II-III NYHA class CHF divided into 2 groups: (I, n=18) with class II CHF and preserved LV ejection fraction (EF) (55+/-10.4%), (II, n=36) with class III CHF and low LF EF (30.4+/-6.8%). MAS was measured by echocardiography as ratio of arterial elasticity (Ea) and end-systolic elasticity of LV myocardium (Es). Serum NT-proBNP was measured by immunoenzyme assay.
During 6 months follow-up one group II patient with initial NT-proBNP level 2020 rg/ml died. NT-proBNP level in group I was significantly lower than in group II (313 and 647 rg/ml, respectively). Ea/Es ratio was significantly higher (p=0.001) in group II. Multifactorial analysis demonstrated moderate correlation of NT-proBNP with Ea/Es ratio (r=0.50, p=0.0001) and negative correlation with LVEF (r=-0.45, =0.003) among patients with II-III class CHF.
As correlation between symptoms and severity of clinical manifestations of ischemic or postinfarction cardiac dysfunction at development of CHF was not high it appears rational to consider MAS estimated by Ea/Es ratio as independent predictor of cardiovascular complications. Sufficiently close correlation between NT-proBNP and Ea/Es ratio allows to improve stratification of risk and to assess objectively prognosis of the disease using easier obtainable parameter Ea/Es in cases when possibility to measure NT-proBNP is not available.
研究心肌-动脉僵硬度（MAS）作为慢性心力衰竭（CHF）合并缺血性或梗死后左心室（LV）功能障碍患者N末端脑钠肽前体（NT-proBNP）表达决定因素的诊断价值。
我们分析了54例纽约心脏协会（NYHA）心功能II-III级CHF患者（平均年龄61.7±8.6岁）的6个月预后情况，这些患者被分为2组：（I组，n = 18）心功能II级且左心室射血分数（EF）保留（55±10.4%），（II组，n = 36）心功能III级且左心室EF较低（30.4±6.8%）。通过超声心动图测量MAS，计算为动脉弹性（Ea）与左心室心肌收缩末期弹性（Es）的比值。采用免疫酶法测定血清NT-proBNP。
在6个月的随访期间，II组中有1例初始NT-proBNP水平为2020 rg/ml的患者死亡。I组的NT-proBNP水平显著低于II组（分别为313和647 rg/ml）。II组的Ea/Es比值显著更高（p = 0.001）。多因素分析表明，在II-III级CHF患者中，NT-proBNP与Ea/Es比值呈中度相关（r = 0.50，p = 0.0001），与左心室EF呈负相关（r = -0.45，p = 0.003）。
由于在CHF发生时，缺血性或梗死后心脏功能障碍的症状与临床表现严重程度之间的相关性不高，因此将通过Ea/Es比值估算的MAS视为心血管并发症的独立预测指标似乎是合理的。NT-proBNP与Ea/Es比值之间存在足够紧密的相关性，这使得在无法测量NT-proBNP的情况下，能够利用更容易获得的参数Ea/Es来改善风险分层并客观评估疾病预后。
