心房颤动患者中心钠肽前体 N 端（NT-proBNP）的心脏内浓度及其分泌的决定因素。

The intracardiac concentrations of the N-terminal-pro B-type natriuretic peptide (NT-proBNP) and the determinants of its secretion in patients with atrial fibrillation.

机构信息

Department of Cardiology, Congenital Heart Diseases, and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland.

出版信息

Kardiol Pol. 2018;76(2):433-439. doi: 10.5603/KP.a2017.0206. Epub 2017 Nov 13.

DOI:10.5603/KP.a2017.0206

PMID:29131295

Abstract

BACKGROUND

N-terminal-pro B-type natriuretic peptide (NT-proBNP) is elevated not only in heart failure (HF) but also in atrial fibrillation (AF). The role and secretion pattern of NT-proBNP in AF is still undetermined.

AIM

The study aimed to assess NT-proBNP concentrations in patients with and without preserved left ventricular ejection fraction (LVEF) depending on the type of AF. It was also intended to define the main source of NT-proBNP production within the heart. In addition, it aimed to study the relation of NT-proBNP with some echocardiographic parameters reflecting the stretch of heart chambers as well as with the chosen parameters of physical capacity.

METHODS

Blood samples were collected from the right atrium (RA), left atrium (LA), and femoral artery (FA) in 53 patients referred for occlusion of the LA appendage. Thirty patients were assigned into Group I (LVEF ≥ 50%, no HF symptoms) and the remaining 23 patients to Group II (LVEF < 50%, HF symptoms). NT-proBNP concentrations were determined using the ELISA test.

RESULTS

In Group I, the lowest NT-proBNP level was found in RA (460.47 ± 723.15 pg/mL and 1097.72 ± 851.42 pg/mL for paroxysmal and permanent AF, respectively), higher in LA (481.5 ± 724.56 pg/mL and 1188.06 ± 851.42 pg/mL for paroxysmal and permanent AF), and the highest values in FA (537.77 ± 808.49 pg/mL and 1188.04 ± 798.28 pg/mL for paroxysmal and permanent AF). In Group II the NT-proBNP values were significantly higher compared to Group I (p < 0.01), but similarly values in RA were the lowest (183.47 ± 1826.08 pg/mL and 2141.68 ± 1801.69 pg/mL for paroxysmal and permanent AF), intermediate values were observed in LA (1857.57 ± 2221.39 pg/mL and 2386.81 ± 2067.2 pg/mL for paroxysmal and permanent AF), and the highest were seen in FA (1936.27 ± 2149.85 and 2437.33 ± 1999.37 pg/mL for paroxysmal and permanent AF, respectively). In Group I, NT-proBNP from LA best correlated with LA area (r = 0.56) and RA area (r = 0.56). In Group II, the strongest correlations were found between NT-proBNP from LA and left ventricular end-systolic dimension (r = 0.57) and volume (r = 0.6).

CONCLUSIONS

NT-proBNP is markedly elevated in the majority of patients with AF even in the absence of HF. LA secretion of NT-proBNP is an important contributor to the overall increase of NT-proBNP also in HF patients. In AF patients, the concentration of NT-proBNP correlates with the remodelling of heart chambers, but not with physical capacity.

摘要

背景

N-末端 pro-B 型利钠肽（NT-proBNP）不仅在心力衰竭（HF）中升高，而且在心房颤动（AF）中也升高。NT-proBNP 在 AF 中的作用和分泌模式仍不确定。

目的

本研究旨在评估具有和不具有保留左心室射血分数（LVEF）的 AF 患者的 NT-proBNP 浓度，取决于 AF 的类型。它还旨在确定 NT-proBNP 在心脏内的主要产生源。此外，它旨在研究 NT-proBNP 与反映心室拉伸的一些超声心动图参数以及与所选身体能力参数之间的关系。

方法

从 53 例因 LA 附件闭塞而就诊的患者的右心房（RA）、左心房（LA）和股动脉（FA）采集血液样本。30 例患者被分配到第 I 组（LVEF≥50%，无 HF 症状），其余 23 例患者分到第 II 组（LVEF<50%，HF 症状）。使用 ELISA 试验测定 NT-proBNP 浓度。

结果

在第 I 组中，RA 中 NT-proBNP 水平最低（阵发性和永久性 AF 分别为 460.47±723.15pg/mL 和 1097.72±851.42pg/mL），LA 中次之（481.5±724.56pg/mL 和 1188.06±851.42pg/mL），FA 中最高（阵发性和永久性 AF 分别为 537.77±808.49pg/mL 和 1188.04±798.28pg/mL）。第 II 组的 NT-proBNP 值明显高于第 I 组（p<0.01），但 RA 中的值仍然最低（阵发性和永久性 AF 分别为 183.47±1826.08pg/mL 和 2141.68±1801.69pg/mL），LA 中的值居中（阵发性和永久性 AF 分别为 1857.57±2221.39pg/mL 和 2386.81±2067.2pg/mL），FA 中的值最高（阵发性和永久性 AF 分别为 1936.27±2149.85pg/mL 和 2437.33±1999.37pg/mL）。在第 I 组中，LA 中的 NT-proBNP 与 LA 面积（r=0.56）和 RA 面积（r=0.56）相关性最佳。在第 II 组中，LA 中的 NT-proBNP 与左心室收缩末期内径（r=0.57）和容量（r=0.6）之间存在最强的相关性。