Carasso Shemy, Grosman-Rimon Liza, Nassar Ali, Kusniec Fabio, Ghanim Diab, Elbaz-Greener Gabby, Kinany Wadi, Sudarsky Doron, Hazanov Evgeni, Amir Offer
Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel.
The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.
Int J Cardiol Heart Vasc. 2019 Apr 9;23:100359. doi: 10.1016/j.ijcha.2019.100359. eCollection 2019 Jun.
The development of malignant pericardial effusion indicates a poor prognosis and is the leading cause of cardiac tamponade. The objectives of the study were to examine the levels of BNP in traumatic, malignant and non-malignant pericardial effusion etiologies, and to assess the value of serum and pericardial fluid BNP levels in the prognosis of malignant pericardial effusion.
A of 56 patients with clinical and echocardiographic diagnosis of pre-tamponade or tamponade who required pericardiocentesis were included in the study. BNP levels were assessed in the serum and within the pericardial fluid. The diagnostic value of BNP levels in discriminating between malignant and non- malignant etiology of pericardial effusion was examined using a receiver-operating characteristic (ROC).
Pericardial fluid BNP levels were similar across all etiology groups. In patients with malignant etiology, the amount of pericardial fluid was high and their serum BNP levels were relatively low. BNP levels were strong predictors of malignant pericardial effusion, and the cut-off point of BNP ≤ 250 pg/ml demonstrated the highest sensitivity (90.0%) for malignant etiology.
Low serum BNP levels were significantly associated with malignancy in patients undergoing pericardiocentesis for pericardial effusions. Serum BNP levels <250 pg/ml may trigger more extensive diagnostic testing for malignant pericardial effusion in patients with small pericardial effusion who are not considered for pericardiocentesis due to small effusion, in whom the etiology is unclear.
恶性心包积液的出现预示着预后不良，是心脏压塞的主要原因。本研究的目的是检测创伤性、恶性和非恶性心包积液病因中脑钠肽（BNP）的水平，并评估血清和心包液BNP水平在恶性心包积液预后中的价值。
本研究纳入了56例经临床和超声心动图诊断为心包填塞前期或心包填塞且需要进行心包穿刺术的患者。对血清和心包液中的BNP水平进行评估。使用受试者操作特征曲线（ROC）来检验BNP水平在鉴别心包积液的恶性和非恶性病因方面的诊断价值。
所有病因组的心包液BNP水平相似。在恶性病因的患者中，心包液量较多，而血清BNP水平相对较低。BNP水平是恶性心包积液的有力预测指标，BNP≤250 pg/ml的临界值对恶性病因显示出最高的敏感性（90.0%）。
对于因心包积液进行心包穿刺术的患者，低血清BNP水平与恶性肿瘤显著相关。对于因积液量小而未考虑进行心包穿刺术且病因不明的心包积液量少的患者，血清BNP水平<250 pg/ml可能会引发对恶性心包积液进行更广泛的诊断性检查。
