Clinical significance of brain natriuretic peptide in patients with postmyocardial infarction

BACKGROUND: Risk stratification after acute myocardial infarction (AMI) includes the evaluation of left ventricular (LV) function. Natriuretic peptides, and particularly brain natriuretic peptide (BNP), emerged as a potential marker of ventricular function and prognosis after AMI. HYPOTHESIS: Brain natriuretic peptide levels are related to ventricular function, either systolic or isolated diastolic, and can give prognostic information in patients surviving AMI. METHODS: In all, 101 patients were enrolled. An echocardiographic (M-mode, two-dimensional, and pulsed Doppler) evaluation was performed and blood samples for BNP measurement were obtained. Clinical events were recorded during 12 months of follow-up. RESULTS: A negative correlation between BNP and LV ejection fraction was observed (r = -0.38; p < 0.001). The BNP levels were higher among patients with LV systolic dysfunction than in patients with isolated diastolic dysfunction (339.1 +/- 249.9 vs. 168.0 +/- 110.5 pg/ml, p = 0.001). The latter had higher levels of BNP than those with normal LV function (68.3 +/- 72.6 pg/ml, p < 0.001). The BNP accuracy to detect LV systolic dysfunction was good (area under the ROC curve [AUC] = 0.83) and increased when isolated diastolic dysfunction was also considered (AUC = 0.87). Brain natriuretic peptide had a very good accuracy in the prediction of death (AUC = 0.95) and the development of heart failure (AUC = 0.90). CONCLUSION: These results extend previous evidence relating BNP to systolic function after AMI. Furthermore, a relationship between BNP levels and diastolic function was found. Brain natriuretic peptide had a very good performance in detecting the occurrence of an adverse event. We conclude that BNP can detect high-risk patients and help select patients for more aggressive approaches.     

急性心肌梗死患者血浆脑尿钠肽与心功能的相关性

目的:探讨急性心肌梗死(AMI)患者血浆脑钠尿肽(BNP)与左心室射血分数(LVEF)、左心室舒张末容积(LVEDV)、Killip分级及心肌梗死部位的关系,评价BNP对AMI患者心功能和危险分层的预测价值。方法:检测120例AMI患者和120例对照组血浆BNP水平,同时行心脏彩色多普勒检测LVEF、LVEDV,比较AMI组与对照组以及不同LVEF、Killip分级和不同梗死部位亚组间的血浆BNP水平差异。结果:与对照组相比,AMI组BNP和LVEDV显著升高,LVEF显著降低(均P<0.01)。与LVEF>50%组比较,LVEF<40%组BNP、LVEDV显著升高(P<0.05);与Killip I、II级比较,Killip III、IV级组BNP显著升高(P<0.05),Killip IV级组LVEDV显著增大(P<0.05)。与下壁心肌梗死患者相比,下后壁、前壁梗死患者BNP显著升高(P<0.05)。BNP与Killip分级成正相关(r=0.97,P<0.05),与LVEF成负相关(r=-0.33,P<0.05)。结论:AMI患者血浆BNP显著增高,尤以LVEF<40%、Killip IV级、前壁心肌梗死者为甚。     

性心肌梗死患者血浆脑钠肽含量的变化

目的：研究急性心肌梗死（AMI）患者与不稳定型心绞痛（UAP）患者血浆脑钠肽（BNP）含量的变化和临床意义。方法i选择我院60例AMI患者（AMI组）和58例UAP患者（UAP组）,检测两组入院时及入院2周后BNP水平,并进行比较分析。结果：入院时,AMI患者BNP水平明显高于UAP组[（1084．7±385．3）pg／m1比（72．57±3．35）pg／ml,P〈0．01];入院2周后,AMI患者BNP水平显著下降[（256．4±134．5）pg／m1],P〈0．01,但仍显著高于UAP组[（65．29±3．62）pg／ml],P〈0．01。结论：血浆脑钠肽水平可反映急性心肌梗死患者心功能恢复的程度,对改善心功能治疗有指导意义。     

急性心肌梗死患者血浆脑钠素浓度的变化及其临床意义

目的：探讨急性心肌梗死（AMI）后血B型利钠肽（BNP）水平的变化及其临床意义。方法：顺序入选2010年1月至2011年10月在我院CCU病房住院的AMI患者200例,其中ST段抬高型心肌梗塞（STEMI）135例为STEMI组,非ST段抬高型心肌梗塞（NsTEMI）65例为NSTEMI组;另选择有心绞痛或冠状动脉无狭窄的患者110例作为心绞痛及正常对照组。采用美国博适公司Triage型BNP定量诊断仪测定BNP浓度。结果：①AMI组BNP浓度明显高于心绞痛及正常对照组[（467±645）pg／ml比（29±50）pg／mi,P〈0．01];②不同类型的心肌梗死（STEMI和NSTEMI）之间BNP水平无明显差异[（586±574）ng／ml比（460±435）ng／ml,P〉0．051。结论：检测B型利钠肽浓度对急性心梗患者的诊断、治疗有重要的临床意义。     

急性心肌梗死KillipⅡ级患者经皮冠状动脉介入治疗后血浆脑钠素、心钠素水平的变化

目的研究急性心肌梗死(acutemyocardialinfarction,AMI)伴左心力衰竭患者经皮冠状动脉介入治疗(PCI)后心钠素(atrialnatriureticpeptide,ANP)和脑钠素(brainnatriureticpeptide,BNP)二种因子的变化及其临床意义。方法入选AMIKillipⅡ级患者40例作为试验组,在AMI1周内行PCI治疗,另入选AMIKillipⅡ级未行PCI治疗患者40例作为对照组。试验组患者于AMI48h内,PCI术后24h,术后1个月时,对照组患者在相对应的时间,采集肘静脉血,采用酶联免疫吸附法分析,测血浆ANP及BNP水平。结果两组间ANP、BNP水平比较,试验组患者AMI48h内,血浆ANP、BNP水平均与对照组相似,两者间无显著性差异(P>0.05)。PCI术后24h,术后1个月ANP、BNP水平均较对照组明显降低,两组间有显著性差异(P<0.05);组内比较,试验组患者PCI术后24hANP、BNP水平较AMI48h内减低,但两者间无显著性差异(P>0.05);PCI术后1月ANP、BNP水平较术前明显回落,两者有显著性差异(P<0.05)。对照组患者在相对应的PCI术后24h,术后1个月这一时限ANP、BNP水平较AMI48h内无明显变化(P>0.05)。结论本研究发现AMIKillipⅡ级患者经PCI治疗可使血浆ANP、BNP水平降低。     

血浆脑钠素水平在心血管病患者中的预后意义

目的探讨血浆脑钠素(BNP)水平对心血管病人全因死亡率的影响,及BNP对患者的预后意义。方法解放军总医院第一附属医院2003年9月至2005年6月期间的住院患者,均有心脏病史,共275例,随访2年,失访2例。根据BNP水平分为3组:BNP<100ng/L,101～1000ng/L,>1000ng/L,比较各组间死亡率的差别,绘制生存曲线。结果随访期间,共死亡42例患者,心源性死亡25例,非心源性死亡17例。3组比较,各组间死亡率比较有统计学意义(P<0.001),随BNP浓度的增加,死亡率逐渐升高。在多因素比较中,年龄和BNP有统计学意义,相对于BNP>1000ng/L,各组BNP对死亡影响的危险比值均<1,说明BNP是影响患者预后的独立危险因素。结论BNP水平是死亡危险增加的一个生化指标,是影响患者预后的一个独立危险因素。     

Influence of exercise on plasma atrial natriuretic factor levels in patients with myocardial infarction

The influence of dynamic exercise on plasma atrial natriuretic factor (ANF) levels was studied in a group of 10 patients with myocardial infarction (MI) and five patients with atypical chest pain (control group). Exercise protocol consisted of three fixed workloads (25, 50, and 75 watts) every 4 minutes with the use of a supine bicycle ergometer. Plasma ANF levels and hemodynamic indices were measured before, during, and 10 minutes after exercise. In the MI group, plasma ANF levels significantly increased at the 75-watt workload and significantly decreased at 10 minutes after exercise, whereas in the control group, the increase in plasma ANP levels after a 75-watt workload, compared with those at rest, was not significant. Significant correlations of pulmonary artery wedge pressure, right atrial pressure, mean arterial pressure, and heart rate to plasma ANF levels were observed at four points obtained before and during each stage of exercise in the MI group. Furthermore, a significant correlation between maximal creatine kinase levels and plasma ANF levels at a 75-watt workload and a significant inverse correlation between left ventricular ejection fraction and plasma ANF levels at a 75-watt workload were observed. These results suggest that the increase in the circulating ANF level during exercise in MI is associated with elevated atrial pressure resulting from left ventricular dysfunction and that measurement of ANF during exercise may be an indication of the severity of MI and associated left ventricular dysfunction.     

早期再灌注对急性心肌梗死患者血浆脑钠素水平的影响

目的 :探讨早期再灌注对急性心肌梗死 (AMI)患者血浆脑钠素 (BNP)水平的影响。方法 :选择AMI患者 5 6例 ,胸痛发作 12h内成功再灌注者 (38例 )为试验组 ,再灌注失败或未进行再灌注者 (18例 )为对照组。ELISA法测定入院即刻、1、2、7、14、2 8d时血浆BNP水平。结果 :AMI患者血浆BNP水平较正常人明显升高 ;试验组血浆BNP水平呈单峰曲线 ,对照组呈双峰曲线 ;再灌注可明显降低AMI患者BNP水平 ,第 7天时浓度升高不明显 ,未形成第 2个高峰。结论 :早期再灌注可明显降低血浆BNP水平。     

急性心肌梗死患者溶栓后血浆中脑钠素浓度变化的研究

目的研究血中脑钠素(BNP)水平与急性心肌梗死溶栓后左心室射血分数(LVEF)和心肌缺血程度的关系。方法将198例顺序入选的急性心肌梗死行链激酶静脉溶栓治疗的患者分为溶栓成功组(105例)和溶栓未成功组(93例),检测所有患者的血BNP水平及测定LVEF,比较溶栓成功组与溶栓未成功组LVEF>40%和LVEF≤40%的BNP水平。结果溶栓成功组BNP水平明显低于溶栓未成功组的BNP水平(725.4±169.8)ng/L(P<0.05),溶栓成功组和未成功组中LVEF>40%患者的BNP水平[(107.7±46.5)ng/L,(488.5±88.9)ng/L]明显低于LVEF≤40%患者的BNP水平[(515.5±121.2)ng/L,(856.7±129.5)ng/L,P<0.01]。结论急性心肌梗死患者血中BNP水平与LVEF和心肌缺血程度有关。     

Discordant atrial natriuretic peptide and brain natriuretic peptide levels in lone atrial fibrillation

OBJECTIVES: We sought to characterize natriuretic peptide levels in a cohort of rigorously characterized subjects with lone atrial fibrillation (AF). BACKGROUND: Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are sensitive biomarkers of cardiac contractile dysfunction. Both peptides have been reported to be elevated in cohorts with AF, but previous studies have included subjects with underlying structural heart disease. We studied these hormones in 150 subjects with lone AF. METHODS: Study subjects had electrocardiographic evidence of at least one episode of AF and a structurally normal heart on echocardiography. Subjects were excluded if they had a history of a myocardial infarction, rheumatic heart disease, cardiomyopathy, significant valvular disease, hyperthyroidism, or hypertension that preceded the onset of AF. Control subjects were obtained from a healthy outpatient primary care population. Plasma pro-ANP and N-terminal pro-BNP (nt-pro-BNP) levels were determined using commercially available immunoassays. RESULTS: A total of 150 serial subjects with lone AF were enrolled and studied, the majority during normal sinus rhythm. Median levels of nt-pro-BNP were significantly elevated in subjects with lone AF as compared with control subjects (166 vs. 133 fmol/ml, p=0.0003). There was no significant difference in pro-ANP levels between subjects with lone AF and control subjects (1,730 vs. 1,625 fmol/ml, p=0.90). CONCLUSIONS: Discordant natriuretic peptide levels were observed in this homogeneous population of subjects with lone AF. This biomarker pattern, which is present even in sinus rhythm, may represent an underlying subclinical predisposition to this common arrhythmia.     

Clinical significance of acute-phase brain natriuretic peptide in acute myocardial infarction treated with direct coronary angioplasty

OBJECTIVES: To investigate the relationship between brain natriuretic peptide (BNP) plasma concentration levels and the clinical course, mortality and success of left ventricular remodeling by direct percutaneous coronary intervention (PCI) in patients with acute myocardial infarction. METHODS: One hundred thirty consecutive first-acute myocardial infarction patients were successfully reperfused by direct PCI. BNP plasma concentration levels were assessed at 24 hr from onset, and patients were divided into the high (> or = 290 pg/ml) plasma BNP group (H-BNP group; n = 65) or low (< 290 pg/ml) plasma BNP subset (L-BNP group; n = 65). Left ventriculography was performed in both the acute (following reperfusion therapy) and chronic (20 +/- 8 days after onset) stages to evaluate left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume index (LVEDVI) and regional wall motion (RWM). Differences between the parameters at the two stages (chronic stage--acute stage) were expressed as delta LVEF, delta LVEDVI, and delta RWM. RESULTS: There were significantly more major complications in the H-BNP group than in the L-BNP group. There was significantly higher mortality in the H-BNP group (p < 0.01). Multivariate analysis identified only BNP plasma concentration as an independent predictor of mortality (p < 0.05). There were no significant differences in left ventricular function in the acute stage between the groups, but LVEF, LVEDVI, and RWM were all significantly worse in the chronic stage in the H-BNP group compared with the L-BNP group. Moreover, delta LVEF (p < 0.001), delta LVEDVI (p < 0.05), and delta RWM (p < 0.01) were also significantly worse in the H-BNP group. CONCLUSIONS: Early-phase BNP plasma concentrations after successful PCI in patients with acute myocardial infarction may be correlated closely with major complications, and may be of prognostic importance. BNP plasma concentration may also be an indicator of left ventricular remodelling.     

N-terminal pro-brain natriuretic peptide levels in patients with non-ST-elevation myocardial infarction

METHODS AND RESULTS: 101 patients hospitalized for acute non-ST-elevation myocardial infarction (NSTEMI) were included in the study. Median N-terminal fragment of the brain natriuretic peptide (BNP) prohormone (Nt-proBNP) plasma level was 136 (40-335) pmol/l. Patients with increasing levels of troponin I [from low (0.1-10 ng/ml), intermediate (10-40 ng/ml) to high (> or =40 ng/ml) levels] had significantly increased levels of Nt-proBNP (p < 0.05). High-risk patients classified by a high PURSUIT score (i.e. supramedian) had significantly increased Nt-proBNP levels compared to patients with low scores (p < 0.001). Moreover, patients with in-hospital events (death, recurrent MI or clinical heart failure: 27%) had significantly increased median levels of Nt-proBNP compared to event-free patients (184 vs. 105 pmol/l, p = 0.02). CONCLUSION: Our data in an unselected population of NSTEMI patients indicate that high levels of circulating Nt-proBNP levels are associated with an increased risk of early cardiovascular events.     

Appearance of atrial natriuretic peptide in the ventricles in patients with myocardial infarction

To study whether atrial natriuretic peptide (ANP) is present in the ventricles in patients with myocardial infarction, we have examined ventricular tissues from five patients with myocardial infarction and five control subjects without cardiovascular diseases by the indirect immunoperoxidase method using monoclonal antibody to alpha-human ANP. Immunoreactivity for ANP was observed in the subendocardial cardiac cells of infarcted as well as noninfarcted segments of the left ventricles in all patients with myocardial infarction. In a case of biventricular infarcts, the subendocardial cardiac cells of the right ventricle were also stained. In a case of ventricular aneurysm, the viable hypertrophied cardiac cells were immunoreactive for ANP throughout the wall of the aneurysm. Immunoreactivity for ANP, however, was not detected in the working ventricular cardiac cells in any of the control subjects. Because ANP improves left ventricular function by reducing both preload and afterload, the appearance of ANP in the ventricles in patients with myocardial infarction may be one of the manifestations of the compensatory mechanism.     

急性心肌梗死患者血脑钠尿肽前体N末端的变化

目的:观察B型脑钠尿肽前体N末端（NT-proBNP）在急性心肌梗死（AM I）患者的变化。方法:应用电化学发光-夹心免疫分析法检测26例首次发生的ST段抬高型透壁性心肌梗死患者的血NT-proBNP,分析其与肌酸激酶MB同工酶、梗死部位和心功能的关系。对照组采用经临床和超声心动图检查无心脏结构和功能异常或其它伴随疾病的轻度高血压或稳定劳力性心绞痛患者22例。结果:AM I患者血NT-proBNP显著高于正常心功能对照组（2097±2008 ng/Lvs70±51 ng/L,P<0.01）。心功能≥Ⅱ级组血NT-proBNP显著高于心功能Ⅰ级组,分别为3172.6±2448.9 ng/L和1175±710.0 ng/L（P<0.01）。NT-proBNP与K illip分级呈正相关。结论:AM I后心脏钠尿肽系统激活,其改变与心功能分级有关,但无心室功能障碍和心房压升高者亦显著升高。     

Relationship between the plasma levels of brain natriuretic peptide and left ventricular ejection fraction in asymptomatic patients with previous myocardial infarction

While the usefulness of measuring the plasma levels of brain natriuretic peptide (BNP) in cases with worsening heart failure and severe heart failure has already been established, the benefits of evaluation of this parameter in asymptomatic stable patients with left ventricular dysfunction is still under debate. Left ventricular function was evaluated in 141 ambulatory outpatients with a previous history of myocardial infarction not associated with symptoms of heart failure for at least one year. The plasma BNP level was also determined in these patients for comparative study. No correlation between the plasma level of BNP and EF was noted in the normal-EF group, while a negative correlation between the two parameters was observed in the low-EF group (Y = 0.439 - 0.000266X) (R2 = 0.244, P < 0.0001). The sensitivity was 91.5%, specificity 56.3%, positive predictive accuracy value 61.9%, and negative predictive accuracy value 83.8% for a plasma BNP cut-off level of 89.0 pg/mL. The results suggested that it might be meaningful to measure the plasma BNP level, especially in asymptomatic patients with a previous history of myocardial infarction having a low-EF.     

脑钠肽心钠肽在心房颤动导管消融术前后的变化

目的:观察脑钠肽(BNP)、心钠肽(ANP)在心房颤动(房颤)导管消融术前、后的变化,探讨其在预测房颤复发的应用价值.方法:连续收集经导管消融术的房颤患者(房颤组)40例,同期连续收集窦性心律患者40例作为对照组,收集房颤组术前、后,对照组入院第2天血清,采用酶联免疫法测定血清BNP浓度.采用放射免疫法测定ANP浓度.结果:房颤组血清BNP浓度显著高于对照组,经过导管消融术后血清BNP、ANP浓度均显著下降,差异有统计学意义,导管消融成功的房颤患者(成功亚组)与对照组BNP浓度无差异,但复发亚组BNP浓度显著高于对照组,差异有统计学意义,术前、后BNP浓度的差值可能与房颤复发有关.结论:BNP对于房颤的诊断与评估及在预测导管消融后房颤复发方面有重要的应用价值.     

Effects of angiotensin-converting enzyme inhibitor on plasma b-type natriuretic peptide levels in patients with acute myocardial infarction

Background: Plasma levels of B-type natriuretic peptide (BNP) are markedly increased in patients with heart failure and acute myocardial infarction. The changes in plasma BNP levels in the treatment of acute myocardial infarction with angiotensin-converting enzyme inhibitors have not been examined well. This study was designed to examine the effects of early angiotensin-converting enzyme inhibitor therapy on plasma BNP levels in patients with acute myocardial infarction.Methods and Results: We measured the plasma levels of B-type natriuretic peptide over the time course for 2 weeks in 30 patients with acute myocardial infarction in whom either imidapril (n = 15) or placebo (n = 15) was given at random immediately after admission. Plasma BNP levels increased and reached a peak of 192 ± 28 pg/ML 16 hours after admission; thereafter, the levels decreased and then again increased, forming the second peak of 217 ± 38 pg/ML on the fifth day (biphasic pattern). On the other hand, plasma BNP levels increased and reached a peak level of 190 ± 22 pg/ML 16 hours after admission and then decreased from 2 days after admission until the second week in the imidapril group (monophasic pattern). Left ventricular ejection fraction measured in the second week was significantly higher in the imidapril group than in the control group (62.2 ± 1.1% vs 51.2 ± 3.6%, P < .01).Conclusions: It is concluded that plasma BNP levels followed a monophasic pattern after imidapril treatment, whereas a biphasic pattern was followed after placebo, and that plasma BNP levels constitute a marker of ventricular dysfunction in the treatment of acute myocardial infarction with angiotensin-converting enzyme inhibitors.     

老年急性心肌梗死患者B型利钠肽和超敏C反应蛋白检测分析

Objective To explore the clinical significance of determination of the serum levels of brain (B-type) natriuretic peptide (BNP) and high-sensitivity C-reactive protein (hs-CRP) in patients with acute myocardial infarction (AMI).Methods The clinical data of 60 cases with AMI and 50healthy controls were analyzed retrospectively.The BNP and hs-CRP levels were analyzed in AMI and Killip class,and their relationship with prognosis was investigated.Results The serum levels of BNP,hs-CRP and creatine kinase (CK)-MB) were higher in AMI group than in control group (all P＜0.05),and the levels were lowered after treatment (P＜0.05).The correlation analysis indicated that BNP and hs-CRP had positive correlations with CK-MB (r=0.892 and 0.683,all P＜0.05),and increased along with the severity of Killip classification.The 8 cases (13.3 % ) died,and single factor analysis revealed that BNP (≥56.1 pmol/L),hs-CRP (≥9.0 mg/L),CK-MB (≥75.1 U/L) and Killip classification (grade Ⅲ and Ⅳ) were the poor prognostic factors (P＜0.05).Conclusions The elevation of BNP and hs-CRP level is correlated with the severity of AMI,and could be used to evaluate the AMI patients' diagnosis and prognosis.     

老年急性心肌梗死患者B型利钠肽和超敏C反应蛋白检测分析

目的 探讨B型利钠肽(BNP)和超敏C反应蛋白(hs-CRP)在急性心肌梗死(AMI)检测中的价值.方法 回顾性分析60例AMI患者和50例健康者的资料,观察BNP和hs-CRP在AMI和Killip分级中的表达特征,并探讨其与预后的关系.结果 治疗前AMI组的BNP、hs-CRP和肌酸激酶同工酶(CK-MB)与对照组比较差异均有统计学意义(P＜0.05),AMI组治疗前后比较差异有统计学意义(P＜0.05).治疗前后BNP、hs-CRP与CK-MB呈正相关(r=0.892,r=0.683,均P＜0.05).BNP、hs-CRP和CK-MB水平随Killip分级的严重程度而升高,呈正相关.BNP、hs-CRP和CK-MB各级别比较差异有统计学意义(P＜0.01).60例中,8例(13.3%)死亡,单因素分析结果显示BNP(≥56.1 pmol/L)、hs-CRP(≥9.0 mg/L)、CK-MB(≥75.1 U/L)和Killip分级Ⅲ、Ⅳ级为AMI患者预后的不良因素(均P＜0.05).结论 BNP和hs-CRP为AMI较为敏感的生化指标,其检测对于AMI的诊断、病情评估及预后具有重要价值.

Abstract：

Objective To explore the clinical significance of determination of the serum levels of brain (B-type) natriuretic peptide (BNP) and high-sensitivity C-reactive protein (hs-CRP) in patients with acute myocardial infarction (AMI).Methods The clinical data of 60 cases with AMI and 50healthy controls were analyzed retrospectively.The BNP and hs-CRP levels were analyzed in AMI and Killip class,and their relationship with prognosis was investigated.Results The serum levels of BNP,hs-CRP and creatine kinase (CK)-MB) were higher in AMI group than in control group (all P＜0.05),and the levels were lowered after treatment (P＜0.05).The correlation analysis indicated that BNP and hs-CRP had positive correlations with CK-MB (r=0.892 and 0.683,all P＜0.05),and increased along with the severity of Killip classification.The 8 cases (13.3 % ) died,and single factor analysis revealed that BNP (≥56.1 pmol/L),hs-CRP (≥9.0 mg/L),CK-MB (≥75.1 U/L) and Killip classification (grade Ⅲ and Ⅳ) were the poor prognostic factors (P＜0.05).Conclusions The elevation of BNP and hs-CRP level is correlated with the severity of AMI,and could be used to evaluate the AMI patients' diagnosis and prognosis.