Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Put doktora Goldmana 4, 21204, Sremska Kamenica, Serbia.
Faculty of Sciences, University of Novi Sad, Sremska Kamenica, Serbia.
Lung. 2018 Oct;196(5):583-590. doi: 10.1007/s00408-018-0137-3. Epub 2018 Jun 27.
Left ventricular systolic dysfunction (LVSD) and cardiac decompensation often accompany AECOPD. Differentiation between the two is difficult and mainly relies on clinical and echocardiographic diagnostic procedures. The value of biomarkers, such as NT-proBNP, as diagnostic tools is still insufficiently investigated. The main goals of this trial were to investigate the value of NT-proBNP as a diagnostic tool for LVSD in AECOPD patients and determine its cut-off value which could reliably diagnose LVSD during AECOPD.
This trial prospectively enrolled 209 patients with AECOPD. The patients were divided into four groups-AECOPD plus chronic pulmonary heart disease (CPHD) with or without left ventricular compromise (LVSD), and AECOPD patients without CPHD with or without LVSD. NT-proBNP was measured within first 48 h of hospitalization.
Majority of patients were male (61%) active smokers (41.6%), average age of 68 years. High quality of echocardiography was obtained in 63.3 and 22.5% of the patients had LVSD. Average value of NT-proBNP in patients with LVSD was 3303.2 vs. 1092.5 pg/mL in patients without LVSD. Significant differences in NT-proBNP value (p = 0.0001) were determined between observed patient groups. At the cut-off value of 1505 pg/mL, sensitivity, specificity, and positive and negative predictive values are 76.6, 83.3, 57.1, and 92.47%, respectively.
At the cut-off value of 1505 pg/mL NT-proBNP could be used as a diagnostic marker for LVSD in acute exacerbation of COPD.
左心室收缩功能障碍（LVSD）和心脏失代偿常伴随 AECOPD。两者的鉴别主要依赖于临床和超声心动图诊断程序。生物标志物如 NT-proBNP 的诊断价值尚未得到充分研究。本试验的主要目的是研究 NT-proBNP 作为 AECOPD 患者 LVSD 诊断工具的价值，并确定其诊断 AECOPD 期间 LVSD 的可靠截断值。
本试验前瞻性纳入 209 例 AECOPD 患者。将患者分为四组-AECOPD 合并慢性肺源性心脏病（CPHD）伴或不伴左心室功能障碍（LVSD）、AECOPD 合并 CPHD 不伴 LVSD 及 AECOPD 不合并 CPHD 不伴 LVSD。于入院后 48 小时内测量 NT-proBNP。
大多数患者为男性（61%）、吸烟者（41.6%），平均年龄 68 岁。63.3%的患者获得高质量的超声心动图，22.5%的患者存在 LVSD。LVSD 患者的 NT-proBNP 平均值为 3303.2pg/mL，无 LVSD 患者为 1092.5pg/mL。观察到的患者组之间的 NT-proBNP 值存在显著差异（p = 0.0001）。在 1505pg/mL 的截断值下，灵敏度、特异性、阳性预测值和阴性预测值分别为 76.6%、83.3%、57.1%和 92.47%。
在 1505pg/mL 的截断值下，NT-proBNP 可作为 AECOPD 患者 LVSD 的诊断标志物。
