Richards A M, Nicholls M G, Yandle T G, Ikram H, Espiner E A, Turner J G, Buttimore R C, Lainchbury J G, Elliott J M, Frampton C, Crozier I G, Smyth D W
Department of Cardiology, Christchurch Hospital, PO Box 4345, Christchurch, New Zealand.
Heart. 1999 Feb;81(2):114-20. doi: 10.1136/hrt.81.2.114.
To determine the relations of plasma levels of brain natriuretic peptide (BNP), atrial natriuretic factor (ANF), N-terminal ANF (N-ANF), cyclic guanosine monophosphate (cGMP; the cardiac peptide second messenger), and plasma catecholamines to left ventricular function and to prognosis in patients admitted with acute myocardial infarction.
Plasma hormones and ventricular function (radionuclide ventriculography) were measured 1-4 days after myocardial infarction in 220 patients admitted to a single coronary care unit. Radionuclide scanning was repeated 3-5 months after infarction. Clinical events were recorded over a mean period of 14 months.
Both early and late left ventricular ejection fraction (LVEF) were most closely related to plasma BNP (r = -0.60, n = 220, p < 0.001; and r = -0.53, n = 192, p < 0.001, respectively), followed by ANF, N-ANF, cGMP, and the plasma catecholamines. Early plasma BNP concentrations less than twofold the upper limit of normal (20 pmol/l) had 100% negative predictive value for LVEF < 40% at 3-5 months after infarction. In multivariate analysis incorporating all the neurohormonal factors, only BNP remained independently predictive of LVEF < 40% (p < 0.005). Survival analysis by median levels of candidate predictors identified BNP as the most powerful discriminator for death (p < 0.0001). No early deaths (within 4 months) occurred in patients with plasma BNP concentrations below the group median (27 pmol/l), and over follow up only three of 26 deaths occurred in this subgroup. Of all episodes of left ventricular failure, 85% occurred in patients with plasma BNP above the median (p < 0.001). In multivariate analyses, BNP alone gave additional predictive information beyond sex, age, clinical history, LVEF, and plasma noradrenaline for both subsequent onset of LVF and death.
Plasma BNP measured within 1-4 days of acute myocardial infarction is a powerful independent predictor of left ventricular function, heart failure, or death over the subsequent 14 months, and superior to ANF, N-ANF, cGMP, and plasma catecholamines.
确定急性心肌梗死患者血浆脑钠肽（BNP）、心钠素（ANF）、N末端心钠素（N-ANF）、环磷酸鸟苷（cGMP；心脏肽类第二信使）及血浆儿茶酚胺水平与左心室功能及预后的关系。
对入住单一冠心病监护病房的220例患者在心肌梗死后1 - 4天测定血浆激素及心室功能（放射性核素心室造影）。梗死后3 - 5个月重复进行放射性核素扫描。平均14个月期间记录临床事件。
早期及晚期左心室射血分数（LVEF）均与血浆BNP相关性最强（r分别为 - 0.60，n = 220，p < 0.001；及r = - 0.53，n = 192，p < 0.001），其次为ANF、N-ANF、cGMP及血浆儿茶酚胺。梗死3 - 5个月时，早期血浆BNP浓度低于正常上限两倍（20 pmol/l）对LVEF < 40%具有100%的阴性预测价值。在纳入所有神经激素因素的多变量分析中，只有BNP仍独立预测LVEF < 40%（p < 0.005）。通过候选预测指标的中位数水平进行生存分析，确定BNP是死亡的最有力判别指标（p < 0.0001）。血浆BNP浓度低于组中位数（27 pmol/l）的患者无早期死亡（4个月内），随访期间该亚组26例死亡中仅3例死亡。在所有左心室衰竭发作中，85%发生在血浆BNP高于中位数的患者中（p < 0.001）。在多变量分析中，仅BNP在性别、年龄、临床病史、LVEF及血浆去甲肾上腺素之外，为随后发生的左心室衰竭及死亡提供了额外的预测信息。
急性心肌梗死后1 - 4天测定的血浆BNP是随后14个月内左心室功能、心力衰竭或死亡的有力独立预测指标，优于ANF、N-ANF、cGMP及血浆儿茶酚胺。
