A change in N-terminal pro-brain natriuretic peptide is predictive of outcome in patients with advanced heart failure

BACKGROUND: The prognosis of chronic heart failure has improved with modern medical therapy. However, identifying those patients who fail to respond to such therapy and therefore those who remain at high risk is notoriously difficult. The B-type natriuretic peptides are established independent predictors of prognosis in CHF. However, the relevance of a change in NT-proBNP concentration over time in advanced heart failure is unknown. METHODS: We prospectively studied 133 patients with advanced CHF referred for consideration of cardiac transplantation. Plasma for NT-proBNP analysis was sampled at baseline and a median of 4 months later in the 112 patients surviving without cardiac transplantation. Patients were followed up for a median of 1003 days. RESULTS: The primary endpoint of all-cause mortality occurred in 30 (26.8%) patients. Those subjects who had the highest NT-proBNP concentration at 4 months were at the greatest risk of death (log rank statistic=10.4, p=0.001). On Cox regression analysis, both a NT-proBNP concentration above the median and an absolute increase in NT-proBNP were independent predictors of mortality (chi(2)=53, p<0.0001 and chi(2)=17.3, p<0.0001, respectively). CONCLUSION: A single NT-proBNP concentration above the median and a change in NT-proBNP concentration over a 4-month period were independent predictors of mortality in patients with advanced heart failure.     

氮末端脑钠素前体鉴别心源性和非心源性呼吸困难价值的研究

目的 探讨氮末端脑钠素前体(NT-proBNP)在鉴别心源性或非心源性疾病引起的呼吸困难中的临床价值.方法 选择2005年8月至2007年3月中山市黄圃人民医院内科心源性呼吸困难患者30例,非心源性疾病呼吸困难患者32例,同期健康体检者30名作为对照组.测量3组左心室射血分数(LVEF)和NT-proBNP,比较NT-proBNP与美国纽约心脏病学会(NYHA)心功能分级及LVEF的关系.结果 对照组、非心源性疾病呼吸困难组、心源性呼吸困难组心脏LVEF分别为(60.82±5.53)%、(55.92±5.62)%和(40.25±4.85)%,差异有统计学意义(P＜0.01).心源性疾病呼吸困难组与对照组和非心源性疾病呼吸困难组间血NT-proBNP质量浓度差异有统计学意义(P＜0.01),对照组与非心源性疾病呼吸困难组间差异无统计学意义(P＞0.05).NT-proBNP与LVEF呈负相关关系.结论 血NT-proBNP浓度与NYHA心功能分级和INEF具有很好的相关性,可能成为鉴别心源性和非心源性疾病引起呼吸困难的指标.     

N末端脑钠肽检测在心力衰竭诊断中的临床应用

目的 探讨血浆N末端脑钠肽(N-terminal pro-brain natriuretic peptide,NT-proBNP)浓度与心力衰竭严重程度的相关性.方法 选择2010年1月至2010年12月在深圳市宝安区观澜人民医院住院的心功能不全患者163例为研究对象.其中6例住院期间死亡(死因为顽固性心力衰竭),10...     

高龄心衰患者血浆N端脑钠肽前体测定的价值

目的探讨高龄心力衰竭患者N端脑钠肽前体（NT—proBNP）与NYHA心功能分级,左室结构、功能的关系;观察治疗前后NT-proBNP水平的动态变化;评价NT-proBNP在高龄心衰患者病情评估中的临床价值。方法选取仁济医院住院治疗的高龄心力衰竭患者49例,13例健康高龄老人纳入对照组,按照纽约心脏病协会（NYHA）对心衰患者进行分级。在治疗前及治疗后两周检测血浆NT—proBNP的浓度;应用心脏彩色多普勒超声诊断仪测定左室结构、功能。结果高龄心衰组患者血浆NT-proBNP值高于健康对照组（P〈0．001）,且随NYHA的心功能分级增高而逐渐升高（P〈0．001）。患者NT—proBNP水平与LVEF呈负相关（P〈0．001）,与LVMI、LVST呈正相关（P〈0．05）。多元回归分析结果显示,NT-proBNP水平与NYHA心功能分级、LVEF、LVMI值相关,与性别、年龄、基础疾病史无相关性。NYHAⅢ级及Ⅳ级心衰患者在治疗前后血浆NT—proBNP水平差异有显著统计学意义（P〈O．05）结论血浆NT—proBNP能较好地反映高龄心力衰竭患者心功能状态,是评估左室功能的客观生化指标,可用于疗效评价的参考。     

N-terminal pro-brain natriuretic peptide in patients with acute pulmonary embolism.

Plasma brain natriuretic peptide (BNP), released from myocytes of ventricles upon stretch, has been reported to differentiate pulmonary from cardiac dyspnoea. Limited data have shown elevated plasma BNP levels in acute pulmonary embolism (APE), frequently accompanied by dyspnoea and right ventricular (RV) dysfunction. The aim of this study was to assess plasma N-terminal proBNP (NT-proBNP) in APE, and to establish whether it reflects the severity of RV overload and if it can be used to predict adverse clinical outcome. On admission, NT-proBNP and echocardiography for RV overload were performed in 79 APE patients (29 males), aged 63 +/- 16 yrs. Plasma NT-proBNP was elevated in 66 patients (83.5%) and was higher in patients with (median 4,650 pg x mL(-1) (range 61-60,958)) than without RV strain (363 pg x mL(-1) (16-16,329)). RV-to-left ventricular ratio and inferior vena cava dimension correlated with NT-proBNP. All 15 in-hospital deaths and 24 serious adverse events occurred in the group with elevated NT-proBNP, while all 13 (16.5%) patients with normal values had an uncomplicated clinical course. Plasma NT-proBNP predicted in-hospital mortality. Plasma N-terminal pro-brain natriuretic peptide is elevated in the majority of cases of pulmonary embolism resulting in right ventricular overload. Plasma levels reflect the degree of right ventricular overload and may help to predict short-term outcome. Acute pulmonary embolism should be considered in the differential diagnosis of patients with dyspnoea and abnormal levels of brain natriuretic peptide.     

Obese subjects with heart failure have lower N-terminal pro-brain natriuretic peptide plasma levels irrespective of aetiology

N-terminal pro-brain natriuretic peptide (NT-proBNP) may be useful in the diagnosis of heart failure and ventricular dysfunction. Obesity is an independent cardiovascular risk factor. The purpose of this study was to measure NT-proBNP plasma levels in obese and non-obese subjects with heart failure and to compare levels in subjects with ischaemic and dilated aetiology. In this study, obese subjects had 63% lower NT-proBNP plasma levels than non-obese subjects (p < 0.01). In multivariate analysis, BMI was inversely associated with NT-proBNP plasma levels (p < 0.05) and a 17% decrease in natriuretic peptide levels was attributed to obesity (p < 0.036). When we analyzed data according to the aetiology of heart failure, we found that both groups (ischaemic and dilated) had a 65% decrease in NT-proBNP plasma levels in obese subjects compared to non-obese subjects.     

Left ventricular cavity area reflects N-terminal pro-brain natriuretic peptide plasma levels in heart failure.

AIMS: N-terminal pro-brain natriuretic peptide (NT-proBNP) is useful in the diagnosis of heart failure (HF). LV two-dimensional cavity area from end-diastole (LVEDA) and end-systole (LVESA), and LV fractional area change (LVFAC) reflect changes in LV morphology and function without using geometric assumptions. In a multicenter study, we correlated LVEDA, LVESA and LVFAC with NT-proBNP, comparing patients with dilated and ischemic cardiomyopathy. METHODS AND RESULTS: We studied 106 HF patients. In the dilated group, NT-proBNP correlated with LVEDAI (r=0.6), LVESAI (r=0.7) and LVFAC (r=-0.6), all significant at p<0.001. In patients with ischemic cardiomyopathy we found LVESAI (r=0.3, p<0.05) and LVFAC (r=-0.4, p<0.01). After adjustment for age and BMI, LVFAC and LVESAI were associated in a multiple linear regression analysis with peptide levels (adjusted r(2)=0.5, p<0.001). CONCLUSIONS: In this study we found a good correlation of NT-proBNP with LV cavity areas and LVFAC. Multiple regression analysis showed that when adjusted for age and BMI, LVFAC and LVESAI are independent predictors of NT-proBNP levels in both dilated and ischemic etiologies. Patients with dilated cardiomyopathy showed better results than those with ischemic cardiomyopathy. We think LV areas are a useful and reproducible parameter, do not need geometric assumptions and reflect NT-proBNP plasma levels.     

合并心力衰竭对慢性阻塞性肺疾病患者血浆氨基酸末端脑钠素前体水平的影响

目的:观察慢性阻塞性肺疾病急性发作(AECOPD)期患者,是否合并心脏疾患引起心力衰竭(心衰),及与单纯心脏疾患引起心衰的血浆N-末端脑钠素前体(NT-proBNP)水平变化的规律及临床意义。方法:利用酶联免疫定量分析(ELISA)法测定血浆中NT-proBNP的浓度,其中AECOPD患者39例(合并心脏疾患引起心衰患者12例);单纯心脏疾患引起心衰15例,同时进行动脉血气分析及超声心动图检查。结果:12例合并心衰的AECOPD患者血浆NT-proBNP值明显高于27例未合并者(P<0.001);血浆NT-proBNP值与左心室舒张末期、收缩末期内径及射血分数存在显著相关性(r=0.471,0.502,-0.522;P=0.003,0.002,0.001);血浆NT-proBNP水平诊断左心收缩功能不全的受试者工作特征(ROC)曲线下面积为0.828。结论:测定血浆NT-proBNP水平可能成为临床诊断AECOPD合并心功能不全有意的参考指标。     

N端脑钠素前体与脑钠素对无症状性心力衰竭的诊断价值

目的探讨N端脑钠素前体（NT-proBNP）与脑钠素（BNP）对无症状性心力衰竭（SHF）的诊断价值。方法通过放射性核素门控心血池显像筛选SHF患者34例。无心力衰竭（HF）症状和体征;HF患者34例,心功能NYHA分级Ⅱ～Ⅲ级;正常健康人30例作为对照组。采用电化学发光双抗体夹心法测定三组血浆NT-proBNP、BNP。结果HF组及SHF组血浆BNP、NT-proBNP显著高于对照组（P〈0．05）,HF组显著高于SHF（P〈0．05）。结论SHF患者血浆BNP和NT-proBNP水平明显高于对照组可判断SHF存在,NT-proBNP升高可能是诊断SHF更好的指标。随HF加重．BNP和NT-proBNP明显增高．此可判断HF的严重程度。     

射血分数正常的心力衰竭患者全血N-末端脑钠肽前体浓度变化

目的评估射血分数正常的心力衰竭（心衰）患者全血N-末端脑钠肽前体（N—terminalpro—brainnatriureticpeptide,NT—pro—BNP）浓度的变化。方法入选78例心脏病患者分为3组：心功能正常组22例,射血分数正常心衰（heartfailurewithpreservedejectionfrction,HFPEF）组33例,射血分数减低心衰（heartfailurewithreducedejectionfraction．HFREF）组23例。测定患者的全血NT—pro．BNP浓度并进行超声心动图检查。结果HFPEF组患者全血NT．proBNP浓度高于心功能正常组[（1424±996）pg／mL vS．（167±117）pg／mL,P〈0．01],低于HFREF组[（1424±996）mg／Lvs（5910±2828）mg／L,P〈0．01],差异有统计学意义。心衰患者全血NT—proBNP浓度与射血分数呈负相关（r=-0．72,P〈0．01）,与左心房内径（r=0．34,P〈0．05）、左心室舒张末内径（r=O．61,P〈0．05）及左心室收缩末内径（r=0．62,P〈0．05）、E／A比值（r=0．40,P〈0．05）呈正相关。结论HFPEF患者全血NT—pro—BNP浓度升高．但升高幅度不如HFREF患者明显。     

Changes of plasma norepinephrine and serum N-terminal pro-brain natriuretic peptide after exercise training predict survival in patients with heart failure

Background

Short-term changes of neurohormones can give important prognostic information in heart failure (HF) patients. In this study, we evaluate whether changes in plasma Norepinephrine (NE) and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) after exercise training predict cardiac mortality in HF patients.

Methods and results

We enrolled 221 HF patients (mean age 72.5 ± 10.2 year) followed-up for a mean period of 27.64 ± 10.7 months. All pts underwent a 3-month exercise training. Before training, clinical examination, echocardiography, peak VO2 determination, and blood draw for NT-proBNP and NE measurements were performed. Primary end-point was cardiac related mortality. Eighty-six-nine percent of patients were in NYHA class III, mean left ventricular ejection fraction (LVEF) was 32.5 ± 10.4%, and mean peak VO2 was 12.36 ± 1.45 ml/kg/min. At baseline, mean NT-proBNP was 2111.4 ± 1145.6 pg/ml and mean NE was 641.8 ± 215.3 pg/ml. One hundred-one subjects died for cardiac causes. Training was associated with a significant increase of peak VO2 and LVEF, whereas NE, NT-proBNP, and heart rate decreased. Multiple Cox proportional hazards regression analysis was performed using delta% values (post vs pre-training) of LVEF, heart rate, NE, and NT-proBNP along with baseline covariates, revealing delta value of NE as the strongest predictor of cardiac mortality. Noteworthy, training reduced NT-proBNP in both survivor and non-survivor patients, while a lack of reduction of NE was observed in non survivors.

Conclusions

In our HF population, short-term changes of NE after exercise training independently predicted long-term cardiac mortality.     

Utility of N-terminal pro-brain natriuretic peptide for the diagnosis of heart failure

BACKGROUND: The goal of this study was to evaluate the utility of plasma N-terminal pro-brain natriuretic peptide for the diagnosis of heart failure in patients presenting with shortness of breath. METHODS AND RESULTS: We measured plasma levels of N-terminal pro-brain natriuretic peptide in 119 patients presenting with shortness of breath. The patients were divided into two groups based on the Framingham criteria and echocardiographic results--those with heart failure and those not in heart failure. Plasma levels of N-terminal pro-brain natriuretic peptide were compared in the two groups. The mean N-terminal pro-brain natriuretic peptide concentration in patients with heart failure (n=73) was higher than that in those not in heart failure (389+/-148 fmol/ml v. 142+/-54 fmol/ml, p<0.001). N-terminal pro-brain natriuretic peptide values increased significantly as the functional severity of heart failure increased (p<0.001). The mean N-terminal pro-brain natriuretic peptide levels were 261+/-34 fmol/ml for patients in New York Heart Association functional class I, 300+/-161 fmol/ml for patients in New York Heart Association functional class II, 427+/-103 fmol/ml for patients in New York Heart Association functional class III and 528+/-170 fmol/ml for patients in New York Heart Association functional class IV. Using a cut-off value of 200 fmol/ml, the sensitivity of N-terminal pro-brain natriuretic peptide was 97%, specificity was 89% and accuracy for differentiating heart failure from other causes of shortness of breath was 93%. CONCLUSIONS: Our results suggest that N-terminal pro-brain natriuretic peptide can be reliably used for the diagnosis of heart failure in an outpatient setting, and this will improve the ability of clinicians to differentiate patients with shortness of breath due to heart failure from those with other causes of shortness of breath.     

Combined measurements of cardiac troponin T and N-terminal pro-brain natriuretic peptide in patients with heart failure.

BACKGROUND: To examine the prognostic contribution of combined cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with heart failure (CHF) in the absence of acute coronary syndrome. METHODS AND RESULTS: Between July 2001 and March 2002, 71 consecutive patients (mean age = 68.4+/-1.4 years, 37 men), hospitalised for heart failure, were studied during hospitalisation and follow up until December 2002. Serum cTnT and NT-proBNP were measured on admission. Actuarial rates of adverse cardiac events, including sudden or CHF death, or rehospitalisation for CHF during follow up were compared with patients grouped according to initial serum cTnT and/or NT-proBNP concentrations. The adverse cardiac event-free rate among the 20 patients with cTnT > or 0.01 ng/ml was significantly lower than the 51 patients with cTnT <0.01 ng/ml (P<0.05). Similarly, the adverse cardiac event-free rate among the 36 patients with NT-proBNP > or =1,357 pg/ml (median) was significantly lower than the 35 patients with NT-proBNP <1,357 pg/ml (P<0.01). The 16 patients with high concentrations of both cTnT and NT-proBNP had a lower adverse cardiac event-free rate than the 31 patients with low cTnT and low NT-proBNP upon commencement of the study (P<0.005). CONCLUSION: Measurements of serum cTnT and NT-proBNP were reliable prognostic markers of adverse cardiac event in patients with CHF.     

N-terminal pro-brain natriuretic peptide levels are elevated in patients with acute ischemic stroke

Brain natriuretic peptide (BNP) is a counterregulatory hormone released by the ventricles of the heart. Its main actions are natriuresis and vasodilation. The authors studied N-terminal pro-brain natriuretic peptide (NT-proBNP) levels soon after an acute ischemic stroke. They compared plasma NT-proBNP concentrations in 30 patients with an acute ischemic stroke with those of 30 controls. The 2 groups were adjusted for age and gender, and there were no significant differences in vascular risk factors and left ventricular systolic and diastolic function. Venous samples were collected within the first 11.8 +/-1.2 hours after the onset of symptoms and again on day 6. Brain computed tomography/magnetic resonance imaging (CT/MRI) was performed on the same days (day 0 and day 6) in order to assess the site (carotid or vertebrobasilar), cause (atherothrombotic, cardioembolic, or lacunar), and size (large, medium, or small) of the brain infarct. NT-proBNP levels were elevated in patients with acute stroke (129.9 +/-9.9 fmol/mL) compared with the controls (90.8 +/-6.3 fmol/mL, p <0.05). These levels remained elevated at day 6 (113.5 +/-13.0 fmol/mL). NT-proBNP at admission was significantly higher in cardioembolic compared with atherothrombotic infarctions. There was no correlation between circulating NT-proBNP and stroke topography, infarct size, or severity as assessed by the National Institutes of Health Stroke Scale (NIHSS) at any of the 2 time points (admission and day 6). NT-proBNP levels were raised in patients with acute ischemic stroke; this effect persisted until day 6. The authors suggest that neurohumoral activation occurs in patients with acute ischemic stroke, either reflecting a counterbalancing vasodilating response to the cerebral ischemia or direct myocardial dysfunction.     

老年心力衰竭患者血浆脑钠肽与N末端B型钠尿肽影响因素的探讨

目的 探讨老年心力衰竭患者血浆脑钠肽(BNP)和N末端B型钠尿肽(NT-proBNP)水平与心力衰竭严重程度、左心室功能等因素的关系,以及肾功能对BNP和NT-proBNP值的影响.方法采用免疫荧光分析法测定106例住院心力衰竭患者BNP水平,采用电化学发光免疫分析法测定48例住院心力衰竭患者NT-proBNP水平.均用心脏彩色多普勒超声诊断仪测定左心室收缩功能,心力衰竭按纽约分级(NYHA). 结果 BNP≤400 ng/L和>400 ng/L患者,左心射血分数(EF)值<45.0%者分别为16.4%和46.8%(χ~2=13.93,P=0.001);心脏彩超A峰、E峰流速比值(E/A)<1者分别为62.3%和40.4%,(χ~2-22.19,P=0.024);肌酐>107 μmol/L者分别为13.1%和38.3%(χ~2=11.31,P=0.002).NT-proBNP≤1800 ng/L和>1800 ng/L患者,EF值<45%者分别为25.0%和58.3%,(χ~2=10.00,P=0.019);E/A≤1者分别为70.1%和20.8%;肌酐>107μmol/L分别为20.8%,和50.0%(χ~2=8.50,P=0.035). 结论 老年心力衰竭患者血浆BNP及NT-proBNP水平随着心力衰竭严重程度的增加而升高,并能较好反映左室功能;肾脏功能对BNP及NT-proBNP水均有影响.     

Prognostic usefulness of anemia and N-terminal pro-brain natriuretic peptide in outpatients with systolic heart failure

N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and anemia are predictors of outcome in systolic heart failure. It is currently unclear how these 2 markers interact in particular with regard to the prognostic information carried by each risk marker. We therefore tested the hypothesis that anemia (World Health Organization criteria, hemoglobin levels <7.5 mmol/L for women and <8.0 mmol/L for men) and NT-pro-BNP are associated and evaluated how a possible association affects the prognostic value of each risk marker. Clinical data from 345 patients with systolic heart failure were obtained prospectively at the baseline visit to our heart failure clinic (inclusion criterion left ventricular ejection fraction <0.45, no exclusion criteria). Follow-up was 30 months (median), and 70 events (mortality) occurred. Prevalence of anemia was 27%. In a multivariate logistic regression model, anemia (p = 0.041) was closely associated with NT-pro-BNP levels above the median (1,381 pg/ml) after adjustment for traditional confounders (left ventricular ejection fraction, age, body mass index, atrial fibrillation, chronic kidney disease). In an adjusted Cox proportional hazard model, the 2 parameters were associated with mortality after adjustment for traditional confounders (hazard ratio for anemia 1.73, 95% confidence interval 1.06 to 2.83, p = 0.029; hazard ratio for NT-pro-BNP >1,381 pg/ml 2.68, 95% confidence interval 1.58 to 4.66, p <0.001). Patients with anemia and high NT-pro-BNP levels had a fivefold increased risk for mortality (hazard ratio 4.77, 95% confidence interval 2.47 to 9.18, p <0.001). In conclusion, anemia is closely associated with NT-pro-BNP in patients with systolic heart failure, and anemia and NT-pro-BNP carry independent prognostic information. Patients with anemia and high levels of NT-pro-BNP have a markedly increased mortality risk.     

N-terminal pro-brain natriuretic peptide reflects pulmonary capillary leakage in patients with acute dyspnea

Natriuretic peptides have proved useful in the diagnosis of heart failure in patients presenting to the emergency department with shortness of breath. Dyspnea and orthopnea in heart failure are clinical expressions of pulmonary capillary congestion and leakage, which may be assessed by the percentage of pulmonary hemosiderin-laden macrophages (HLM) in induced sputum. We found a significant difference in the percentage of HLM present in sputum among patients with acute heart failure, patients with noncardiac dyspnea with ventricular dysfunction, and patients without heart failure (p = 0.008). N-terminal pro-brain natriuretic peptide (N-BNP) concentrations were also different among these 3 patient groups (p = 0.006). N-BNP concentrations were positively associated with the percentage of HLM in patients with acute dyspnea (r = 0.6; p < 0.0001). N-BNP, in addition to being a ventricular dysfunction marker, may reflect the severity of pulmonary capillary congestion and leakage in patients with acute shortness of breath.     

N-末端前体脑钠肽对终末期肾脏病患者心力衰竭的诊断价值研究

目的 探讨N-末端前体脑钠肽(NT-proBNP)在终末期肾脏病(ESRD)患者合并心力衰竭时的早期诊断价值。评估ESRD患者血浆NT-proBNP诊断心力衰竭的临界值。方法 选取2012年1月至2013年3月大连医科大学附属第二医院肾内科的CKD 5期患者63例,根据临床症状体征、超声心动图以左室射血分数(LVEF)下降分为肾衰心力衰竭组(31例)和单纯肾衰组(32例),同时选取心内科心力衰竭患者(32例),另外选取同期体检人员为对照组(30例),采用双抗体夹心原理的一步法酶免疫法测定血浆NT-proBNP水平。结果 肾衰心力衰竭组、单纯肾衰组、单纯心力衰竭组及正常对照组血浆NT-proBNP分别为(40 414.99±35 160.62)ng/L、(16 884.37±16 362.34)ng/L、(3229.19±2606.05)ng/L和(98.26±15.63)ng/L,两两比较差异均有统计学意义。以慢性肾衰心力衰竭组为实验组分析ROC曲线下面积为0.726,95%的可信区间0.602～0.849。当临界值为9934.75 ng/L时,计算NT-proBNP对肾衰心力衰竭中的诊断价值：灵敏度83.9%,特异度78.1%,正确诊断指数1.62。阳性预测值为79%,阴性预测值为83%。结论 血浆NT-proBNP受肾功能的影响;肾功能损害时诊断心力衰竭时NT-proBNP临界值应相应提高;NT-proBNP测定诊断终末期肾脏病患者心力衰竭有较高的准确性。