经皮球囊二尖瓣成形术后风湿性二尖瓣狭窄患者的血浆心钠素和脑钠肽水平

ANP and BNP plasma levels in patients with rheumatic mitral stenosis after percutaneous balloon mitral valvuloplasty.

作者信息

Mazurkiewicz Łukasz, Rużyłło Witold, Chmielak Zbigniew, Opalińska-Ciszek Ewa, Janas Jadwiga, Hoffman Piotr, Hryniewiecki Tomasz, Grzybowski Jacek

机构信息

Department of Cardiomyopathies, CMR Unit, Institute of Cardiology, Warsaw, Poland.

Institute of Cardiology, Warsaw, Poland.

出版信息

Postepy Kardiol Interwencyjnej. 2017;13(1):18-25. doi: 10.5114/aic.2017.66182. Epub 2017 Mar 10.

DOI:10.5114/aic.2017.66182

PMID:28344613

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5364278/

Abstract

INTRODUCTION

Atrial (ANP) and B-type (BNP) natriuretic peptides are hormones secreted by the heart as a response to volume expansion and pressure overload.

AIM

To assess the changes of ANP and BNP after percutaneous balloon mitral valvuloplasty (PBMV) and to investigate factors associated with endpoints.

MATERIAL AND METHODS

The study included 96 patients (90.7% females, age 51.6 ±12.2 years) with rheumatic mitral valve stenosis (mitral valve area (MVA) 1.18 (1.01-1.33) cm, mean mitral gradient (MMG) 8.2 (7.1-9.2) mm Hg, NYHA 2.09 (1.9-2.5)). Patients were followed up for 29.1 months for the search of endpoints.

RESULTS

The PBMV was successful in all cases. After the procedure MVA increased (1.18-1.78 cm, < 0.01) and pulmonary capillary wedge pressure (PCWP) decreased (29.8-21.8 mm Hg, < 0.01). Concentration of ANP significantly rose 30 min after the PBMV (79.2 vs. 134.2 pg/ml, = 0.012) and dropped significantly after 24 h (134.2 vs. 70.4 pg/ml, = 0.01). Furthermore, after 36 months concentration of ANP did not differ from the baseline value ( = NS). BNP concentration at day 1 was lower than at baseline (94.5 vs. 80.2 pg/ml, = 0.032). Moreover, during the follow-up period BNP continued to fall at all time points. In univariate analysis parameters associated with endpoint occurrence were baseline PAP ( = 0.023), baseline PCWP ( = 0.022), baseline NYHA ( = 0.041) and increase in 6-minute walk test (6MWT) ( = 0.043). In multivariate analysis the only factor associated with endpoint occurrence was baseline NYHA (HR = 1.52, 95% CI: -1.3-1.91, = 0.022).

CONCLUSIONS

Patients with MS had increased levels of both BNP and ANP. Baseline NYHA class was found to be associated with outcomes after the procedure.

摘要

引言

心房钠尿肽（ANP）和B型钠尿肽（BNP）是心脏分泌的激素，作为对容量扩张和压力过载的反应。

目的

评估经皮球囊二尖瓣成形术（PBMV）后ANP和BNP的变化，并研究与终点相关的因素。

材料和方法

该研究纳入了96例风湿性二尖瓣狭窄患者（女性占90.7%，年龄51.6±12.2岁），二尖瓣面积（MVA）为1.18（1.01 - 1.33）cm²，平均二尖瓣压差（MMG）为8.2（7.1 - 9.2）mmHg，纽约心脏协会（NYHA）心功能分级为2.09（1.9 - 2.5）级。对患者进行29.1个月的随访以寻找终点事件。

结果

所有病例的PBMV均成功。术后MVA增加（从1.18至1.78 cm²，P < 0.01），肺毛细血管楔压（PCWP）降低（从29.8至21.8 mmHg，P < 0.01）。PBMV后30分钟ANP浓度显著升高（79.2对134.2 pg/ml，P = 0.012），24小时后显著下降（134.2对70.4 pg/ml，P = 0.01）。此外，36个月后ANP浓度与基线值无差异（P = 无统计学意义）。第1天的BNP浓度低于基线（94.5对80.2 pg/ml，P = 0.032）。而且，在随访期间BNP在所有时间点持续下降。单因素分析中，与终点事件发生相关的参数为基线肺动脉压（P = 0.023）、基线PCWP（P = 0.022）、基线NYHA（P = 0.041）和6分钟步行试验（6MWT）增加量（P = 0.043）。多因素分析中，与终点事件发生相关的唯一因素是基线NYHA（风险比[HR] = 1.52，95%置信区间：1.3 - 1.91，P = 0.022）。