Richards A M, Nicholls M G, Yandle T G, Frampton C, Espiner E A, Turner J G, Buttimore R C, Lainchbury J G, Elliott J M, Ikram H, Crozier I G, Smyth D W
Department of Cardiology, Christchurch Hospital, Christchurch School of Medicine, New Zealand.
Circulation. 1998 May 19;97(19):1921-9. doi: 10.1161/01.cir.97.19.1921.
Newly discovered circulating peptides, N-terminal pro-brain natriuretic peptide (N-BNP) and adrenomedullin (ADM), were examined for prediction of cardiac function and prognosis and compared with previously reported markers in 121 patients with myocardial infarction.
The association between radionuclide left ventricular ejection fraction (LVEF) and N-BNP at 2 to 4 days (r=-.63, P<.0001) and 3 to 5 months (r=-.58, P<.0001) after infarction was comparable to that for C-terminal BNP and far stronger than for ADM (r=-.26, P<.01), N-terminal atrial natriuretic peptide (N-ANP), C-terminal ANP, cGMP, or plasma catecholamine concentrations. For prediction of death over 24 months of follow-up, an early postinfarction N-BNP level > or = 160 pmol/L had sensitivity, specificity, positive predictive value, and negative predictive values of 91%, 72%, 39%, and 97%, respectively, and was superior to any other neurohormone measured and to LVEF. Only 1 of 21 deaths occurred in a patient with an N-BNP level below the group median (Kaplan-Meier survival analysis, P<.00001). For prediction of heart failure (left ventricular failure), plasma N-BNP > or = 145 pmol/L had sensitivity (85%) and negative predictive value (91%) comparable to the other cardiac peptides and was superior to ADM, plasma catecholamines, and LVEF. By multivariate analysis, N-BNP but not ADM provided predictive information for death and left ventricular failure independent of patient age, sex, LVEF, levels of other hormones, and previous history of heart failure, myocardial infarction, hypertension, or diabetes.
Plasma N-BNP measured 2 to 4 days after myocardial infarction independently predicted left ventricular function and 2-year survival. Stratification of patients into low- and high-risk groups can be facilitated by plasma N-BNP or BNP measurements, and one of these could reasonably be included in the routine clinical workup of patients after myocardial infarction.
在121例心肌梗死患者中，检测新发现的循环肽N末端前脑钠肽（N-BNP）和肾上腺髓质素（ADM）对心脏功能和预后的预测价值，并与先前报道的标志物进行比较。
梗死2至4天（r = -0.63，P < 0.0001）和3至5个月（r = -0.58，P < 0.0001）时，放射性核素左心室射血分数（LVEF）与N-BNP的相关性与C末端脑钠肽相当，且远强于ADM（r = -0.26，P < 0.01）、N末端心房钠尿肽（N-ANP）、C末端ANP、cGMP或血浆儿茶酚胺浓度。对于随访24个月内死亡的预测，梗死早期N-BNP水平≥160 pmol/L的敏感性、特异性、阳性预测值和阴性预测值分别为91%、72%、39%和97%，优于其他任何检测的神经激素和LVEF。21例死亡患者中仅1例N-BNP水平低于组中位数（Kaplan-Meier生存分析，P < 0.00001）。对于心力衰竭（左心室衰竭）的预测，血浆N-BNP≥145 pmol/L的敏感性（85%）和阴性预测值（91%）与其他心脏肽相当，且优于ADM、血浆儿茶酚胺和LVEF。多因素分析显示，N-BNP而非ADM可独立于患者年龄、性别、LVEF、其他激素水平以及心力衰竭、心肌梗死、高血压或糖尿病既往史，为死亡和左心室衰竭提供预测信息。
心肌梗死后2至4天检测的血浆N-BNP可独立预测左心室功能和2年生存率。血浆N-BNP或BNP检测有助于将患者分为低风险和高风险组，其中之一可合理纳入心肌梗死患者的常规临床检查。
