Arakawa N, Nakamura M, Aoki H, Hiramori K
Second Department of Internal Medicine, Iwate Medical University, Japan.
J Am Coll Cardiol. 1996 Jun;27(7):1656-61. doi: 10.1016/0735-1097(96)00067-8.
This study sought to examine whether plasma brain natriuretic peptide levels can predict prognosis after myocardial infarction.
It has been suggested that concentrations of plasma brain natriuretic peptide reflect left ventricular function. Although the prognosis after myocardial infarction depends on residual left ventricular function, it is not known whether plasma levels of brain natriuretic peptide after the onset of myocardial infarction can be used to predict long-term outcome.
Plasma brain natriuretic peptide and atrial natriuretic peptide levels as well as invasive hemodynamic variables were measured in 70 patients with acute myocardial infarction (53 men, 17 women; mean age 65 years). Measurements were obtained on admission (mean 6 h after onset) and on day 2 after onset. Mean follow-up period was 18 months.
Plasma brain natriuretic peptide levels measured on admission and day 2 correlated significantly with hemodynamic variables, which are influenced by left ventricular function. However, plasma atrial natriuretic peptide levels correlated with none of the hemodynamic variables measured on admission; and of those measured on day 2, plasma atrial natriuretic peptide levels correlated only with left atrial filling pressure. During the follow-up period (mean 18 +/- 7 months), 11 patients died of cardiac causes. By Kaplan-Meier analysis, it was found that patients with plasma brain natriuretic peptide levels higher than the median level, both on admission and on day 2, had significantly higher mortality rates than those with the submedian level (on admission, p < 0.01; on day 2, p < 0.05). However, only the plasma atrial natriuretic peptide level obtained immediately after admission was significantly related to survival (p < 0.01). By Cox proportional hazards model analysis of the noninvasive variables, it was found that plasma brain natriuretic peptide concentration was more closely related to survival after myocardial infarction (p = 0.0001).
Increased plasma brain natriuretic peptide concentrations in the early or subacute phase of myocardial infarction are a powerful noninvasive indicator of poor prognosis, possibly reflecting residual left ventricular function after myocardial infarction.
本研究旨在探讨血浆脑钠肽水平是否能够预测心肌梗死后的预后。
已有研究表明，血浆脑钠肽浓度可反映左心室功能。虽然心肌梗死后的预后取决于左心室残余功能，但心肌梗死后血浆脑钠肽水平是否可用于预测长期预后尚不清楚。
对70例急性心肌梗死患者（53例男性，17例女性；平均年龄65岁）测定血浆脑钠肽和心房钠尿肽水平以及有创血流动力学变量。在入院时（发病后平均6小时）和发病后第2天进行测量。平均随访期为18个月。
入院时和第2天测得的血浆脑钠肽水平与受左心室功能影响的血流动力学变量显著相关。然而，入院时测得的血浆心房钠尿肽水平与任何血流动力学变量均无相关性；在第2天测得的血流动力学变量中，血浆心房钠尿肽水平仅与左心房充盈压相关。在随访期（平均18±7个月），11例患者死于心脏原因。通过Kaplan-Meier分析发现，入院时和第2天血浆脑钠肽水平高于中位数水平的患者死亡率显著高于低于中位数水平的患者（入院时，p<0.01；第2天，p<0.05）。然而，仅入院后立即测得的血浆心房钠尿肽水平与生存率显著相关（p<0.01）。通过对无创变量进行Cox比例风险模型分析发现，血浆脑钠肽浓度与心肌梗死后的生存率更密切相关（p=0.0001）。
心肌梗死早期或亚急性期血浆脑钠肽浓度升高是预后不良的有力无创指标，可能反映心肌梗死后的左心室残余功能。
