Cardiovascular Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
Institute of Genetic Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
ESC Heart Fail. 2019 Apr;6(2):449-454. doi: 10.1002/ehf2.12424. Epub 2019 Feb 20.
N-terminal prohormone of brain natriuretic peptide (NT-proBNP) plays an important role in diagnosis and management of heart failure. The aim of the present study was to assess haemodynamic response to exercise and to evaluate the relationship between NT-proBNP, cardiac function, and exercise tolerance in chronic heart failure.
A single-centre, cross-sectional pilot study recruited 17 patients with chronic heart failure with reduced left ventricular ejection fraction (age 67 ± 7 years) and 20 healthy volunteers (age 65 ± 12 years). The NT-proBNP was measured in the heart failure group. All participants completed maximal graded cardiopulmonary exercise stress testing coupled with gas exchange (using metabolic analyser for determination of exercise tolerance, i.e. peak O consumption) and continuous haemodynamic measurements (i.e. cardiac output and cardiac power output) using non-invasive bioreactance technology. Heart failure patients demonstrated significantly lower peak exercise cardiac function and exercise tolerance than healthy controls, i.e. cardiac power output (5.0 ± 2.0 vs. 3.2 ± 1.2 W, P < 0.01), cardiac output (18.2 ± 6.3 vs. 13.5 ± 4.0 L/min, P < 0.01), heart rate (148 ± 23.7 vs. 111 ± 20.9 beats/min, P < 0.01), and oxygen consumption (24.3 ± 9.5 vs. 16.8 ± 3.8 mL/kg/min, P < 0.01). There was no significant relationship between NT-proBNP and cardiac function at rest, i.e. cardiac power output (r = -0.28, P = 0.28), cardiac output (r = -0.18, P = 0.50), and oxygen consumption (r = -0.18, P = 0.50), or peak exercise, i.e. cardiac power output (r = 0.18, P = 0.49), cardiac output (r = 0.13, P = 0.63), and oxygen consumption (r = -0.05, P = 0.84).
Lack of a significant and strong relationship between the NT-proBNP and measures of cardiac function and exercise tolerance may suggest that natriuretic peptides should be considered with caution in interpretation of the severity of cardiac dysfunction and functional capacity in chronic heart failure.
脑利钠肽前体（NT-proBNP）在心力衰竭的诊断和治疗中起着重要作用。本研究旨在评估慢性心力衰竭患者运动时的血液动力学反应，并评估 NT-proBNP 与心功能和运动耐量之间的关系。
一项单中心、横断面的试点研究招募了 17 名射血分数降低的慢性心力衰竭患者（年龄 67 ± 7 岁）和 20 名健康志愿者（年龄 65 ± 12 岁）。心力衰竭组测量了 NT-proBNP。所有参与者都完成了最大分级心肺运动应激测试，并结合气体交换（使用代谢分析仪确定运动耐量，即峰值 O 消耗）和使用非侵入性生物电阻抗技术的连续血液动力学测量（即心输出量和心功率输出）。心力衰竭患者的峰值运动心功能和运动耐量明显低于健康对照组，即心功率输出（5.0 ± 2.0 对 3.2 ± 1.2 W，P < 0.01）、心输出量（18.2 ± 6.3 对 13.5 ± 4.0 L/min，P < 0.01）、心率（148 ± 23.7 对 111 ± 20.9 beats/min，P < 0.01）和耗氧量（24.3 ± 9.5 对 16.8 ± 3.8 mL/kg/min，P < 0.01）。NT-proBNP 与静息时的心功能（即心功率输出，r = -0.28，P = 0.28；心输出量，r = -0.18，P = 0.50；耗氧量，r = -0.18，P = 0.50）或峰值运动（即心功率输出，r = 0.18，P = 0.49；心输出量，r = 0.13，P = 0.63；耗氧量，r = -0.05，P = 0.84）之间没有显著的关系。
NT-proBNP 与心功能和运动耐量的测量之间缺乏显著和强烈的关系，这可能表明在解释慢性心力衰竭中心功能障碍的严重程度和功能能力时，应谨慎考虑利钠肽。
