N 端前 B 型利钠肽及左心室舒张功能与重度瓣膜性心脏病且左心室收缩功能正常患者运动耐量的关系

Relation of N-Terminal Pro-B-Type Natriuretic Peptide and Left Ventricular Diastolic Function to Exercise Tolerance in Patients With Significant Valvular Heart Disease and Normal Left Ventricular Systolic Function.

作者信息

Hwang Ji-Won, Park Sung-Ji, Cho Eun Jeong, Kim Eun Kyoung, Lee Ga Yeon, Chang Sung-A, Choi Jin-Oh, Lee Sang-Chol, Park Seung Woo

机构信息

Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

出版信息

Am J Cardiol. 2017 Jun 1;119(11):1846-1853. doi: 10.1016/j.amjcard.2017.02.038. Epub 2017 Mar 16.

DOI:10.1016/j.amjcard.2017.02.038

PMID:28391990

Abstract

An association between N-terminal prohormone brain natriuretic peptide (NT-proBNP) and exercise tolerance in patients with valvular heart disease (VHD) has been suggested; however, there are few data available regarding this relation. The aim of this study is to evaluate the correlation between exercise tolerance and NT-proBNP in patients with asymptomatic or mildly symptomatic significant VHD and normal left ventricular ejection fraction (LV EF). A total of 96 patients with asymptomatic or mildly symptomatic VHD and normal LV EF (≥50%) underwent cardiopulmonary exercise echocardiography. NT-proBNP levels were determined at baseline and after exercise in 3 hours. Patients were divided in 2 groups based on lower (<26 ml/kg/min, n = 47) or higher (≥26 ml/kg/min, n = 49) peak oxygen consumption (VO) as a representation of exercise tolerance. In the 2 groups, after adjusting for age and gender, the NT-proBNP level after exercise in 3 hours, left atrial volume index before exercise, right ventricular systolic pressure before exercise, E velocity after exercise, and E/e' ratio after exercise varied significantly. In addition, peak VO was inversely related to NT-proBNP before (r = -0.352, p <0.001) and after exercise (r = -0.351, p <0.001). The NT-proBNP level before exercise was directly related to the left atrial volume index, E/e' ratio, and right ventricular systolic pressure before and after exercise. NT-proBNP after exercise was also directly related to the same parameters. NT-proBNP levels both before and after exercise were higher in the group with lower exercise tolerance. In conclusion, through the correlation among exercise tolerance, NT-proBNP, and parameters of diastolic dysfunction, we demonstrated that diastolic dysfunction and NT-proBNP could predict exercise tolerance in patients with significant VHD and normal LV EF.

摘要

已有研究表明，N末端前体脑钠肽（NT-proBNP）与瓣膜性心脏病（VHD）患者的运动耐量之间存在关联；然而，关于这种关系的数据却很少。本研究的目的是评估无症状或轻度症状性严重VHD且左心室射血分数（LV EF）正常的患者运动耐量与NT-proBNP之间的相关性。共有96例无症状或轻度症状性VHD且LV EF正常（≥50%）的患者接受了心肺运动超声心动图检查。在基线和运动后3小时测定NT-proBNP水平。根据较低（<26 ml/kg/min，n = 47）或较高（≥26 ml/kg/min，n = 49）的峰值耗氧量（VO）将患者分为两组，峰值耗氧量作为运动耐量的指标。在这两组中，调整年龄和性别后，运动后3小时的NT-proBNP水平、运动前左心房容积指数、运动前右心室收缩压、运动后E波速度以及运动后E/e'比值有显著差异。此外，峰值VO与运动前（r = -0.352，p <0.001）和运动后（r = -0.351，p <0.001）的NT-proBNP呈负相关。运动前NT-proBNP水平与运动前后的左心房容积指数、E/e'比值以及右心室收缩压直接相关。运动后NT-proBNP也与相同参数直接相关。运动耐量较低的组运动前后的NT-proBNP水平均较高。总之，通过运动耐量、NT-proBNP和舒张功能障碍参数之间的相关性，我们证明舒张功能障碍和NT-proBNP可以预测严重VHD且LV EF正常的患者的运动耐量。