Influence of gender on circulating cardiac natriuretic hormones in patients with heart failure.

In order to study the influence of gender on circulating levels of cardiac natriuretic hormones (CNHs) in heart failure, we measured the plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) by means of highly sensitive and specific IRMA methods in 239 consecutive patients (age 64.7 +/- 11.6 years, range 21-89 years; 170 men and 69 women) with cardiomyopathy. There was different response of CNH according to gender in patients with heart failure, as indicated by the ratio between the individual CNH values of patients and the gender-specific cut-off values. Indeed, the mean ratio for ANP found in men (3.6 +/- 3.6) was significantly higher (p = 0.0075) than that found in women (2.4 +/- 2.1). The mean ratio for BNP was on average 2.3 fold higher (15.9 +/- 27.1 in men and 6.9 +/- 6.8 in women, p = 0.0084). Moreover, age, ejection fraction, and disease severity independently and significantly contributed to regression with both ANP (R = 0.612, F = 39.969, p < 0.0001) and BNP (R = 0.656, F = 49.957, p < 0.0001) values, while gender did not. In conclusion, our study suggests a different, gender-specific activation of the CNH system in this clinical condition, although age, ejection fraction and disease severity seem to be more powerful predictors than gender of circulating levels of ANP and BNP in patients with heart failure.     

慢性心力衰竭患者甲状腺激素水平变化的相关研究

【目的】探讨慢性心力衰竭（CHF）患者血清甲状腺激素水平的变化特点,以及合并正常甲状腺功能病态综合征（ESS）患者的血浆脑钠肽（BNP）水平变化。【方法】选取CHF患者104例（NYHAⅡ级38例,Ⅲ级40例,Ⅳ级26例）,对照组（NYHAⅠ级）23例,分别测定血清T3、FT3、T4、FT4、TSH、BNP、左室射血分数（LVEF）,比较ESS组和非ESS组之间BNP、LVEF等指标变化。【结果】①不同心功能组T3、FT3、T4、FT4水平随心功能不全的加重而下降,ESS发生率依次升高;②CHF合并ESS患者BNP明显升高,LVEF下降、LVEDD扩大、心率增快。【结论】CHF合并ESS患者,心肌结构和神经内分泌系统改变更严重。     

Measurement of cardiac natriuretic hormones (atrial natriuretic peptide, brain natriuretic peptide, and related peptides) in clinical practice: the need for a new generation of immunoassay methods

BACKGROUND: Cardiac natriuretic hormones (CNHs) are a family of related peptides, including atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and other peptides derived from the N-terminal portion of the proANP and proBNP peptide chains. Assays for cardiac natriuretic peptides have been proposed to help assess clinical conditions associated with expanded fluid volume. In particular, the assays can be useful for distinguishing healthy subjects from patients in different stages of heart failure. Measurements of these hormones have also been considered for prognostic indicators of long-term survival in patients with heart failure and/or after acute myocardial infarction. The different CNHs differ in their production/secretion patterns and have different clearance rates. Furthermore, there are numerous proposed assay configurations for each of these hormones, and it is not clear which assay provides the best pathophysiological and/or clinical information. APPROACH: Here we review recent studies concerning the competitive (such as RIA, enzyme immunoassay, or luminescence immunoassay) and noncompetitive immunoassays (such as two-site IRMA, ELISA, or immunoluminometric assay) for the different cardiac natriuretic peptides to compare the analytical characteristics and clinical relevance of assays for the different CNHs and the different assay formats. CONTENT: Developing sensitive, precise, and accurate immunoassays for cardiac natriuretic peptides has been difficult because of their low concentrations (on average, approximately 3-6 pmol/L) in healthy subjects and because of their structural, metabolic, and physiological characteristics. Competitive assays have historically suffered from lack of sensitivity and specificity for the biologically active peptides. These usually require tedious extraction procedures prior to analysis. Recently, immunometric assays have been developed that have improved sensitivity and specificity; it appears these will be the methods of choice. SUMMARY: To date, there is no consensus on the best assay procedure of cardiac natriuretic peptides. To facilitate widespread propagation of determination of these hormones in routine clinical practice, it will be necessary to study the new generation of noncompetitive immunometric methods that are less time-consuming and more sensitive and specific. Although several studies suggest that BNP exhibits better clinical utility than the other CNHs, more studies examining multiple CNHs in the same cohorts of patients will be necessary.     

Relationship between natriuretic peptides and hemodynamics in patients with heart failure at rest and after ergometric exercise

Sixteen patients with heart failure who underwent right heart catherization were studied with regard to plasma natriuretic peptide levels and hemodynamic parameters at rest and immediately after symptom-limited ergometry. Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were measured and correlated with left ventricular ejection fraction (LVEF), mean pulmonary arterial pressure (MPAP), pulmonary arterial wedge pressure (PAWP) and cardiac index (CI). Compared to normal controls, ANP and BNP were elevated at rest. During exercise ANP and BNP increased. BNP was highly significantly correlated with LVEF (P = 0.005) at rest, whereas ANP did not (P = 0.082). BNP significantly correlated with MPAP and PAWP after exercise and showed a significant inverse correlation with CI. Our data provide evidence that BNP might be a better indicator for LVEF at rest than ANP. In addition, BNP correlates very well with MPAP and PAWP, after exercise. This close correlation is likely to reflect a correlation of BNP with left ventricular enddistolic pressure in heart failure when patients are exposed to physical exercise.     

老年心力衰竭患者心功能对血浆脑钠肽水平的影响

目的探讨血浆脑钠肽（BNP）水平与老年心力衰竭患者心力衰竭严重程度的关系。方法对33例老年心力衰竭患者[观察组,按美国纽约心脏病学会（NYHA）心功能分级：Ⅱ级7例,Ⅲ级20例,Ⅳ级6例]和32例健康老年人（对照组）清晨平卧抽血（患者于入院24h内及出院时）3mL,测定血浆BNP水平;超声心动图测定左室射血分数（LVEF）、左室舒张末期内径值（LVEDD）。比较2组及心功能衰竭各亚组间血浆BNP水平。结果观察组LVEF值低于对照组、LVEDD及血浆BNP水平高于对照组（P〈0．05或P〈O．01）。心力衰竭发作时,观察组中心功能Ⅲ、Ⅳ级组的血浆BNP水平显著高于心功能Ⅱ级组（均P〈0．05）。结论老年心力衰竭患者血浆BNP水平增高程度与心力衰竭的严重程度呈正比．可以作为评定心力衰竭进程和预后的指标。     

血浆脑钠素水平与心衰患者左心功能变化的关系

[目的]探讨血浆脑钠素（BNP）水平与心力衰竭患者临床心功能变化之间的关系.[方法] 采用免疫放射分析法（IRMA）测定患者血浆BNP水平,同时采用纽约心脏协会心功能分级（NYHA）心功能分级和超声心动图检查评定患者左心功能.[结果] 随着心功能恶化,血浆BNP水平呈上升趋势,各级心功能间差异均有显著性（P〈0.01）.经抗心衰药物综合治疗后,BNP水平降低（P〈0.01）.BNP水平与左心室射血分数（LVEF）、左心室短轴缩短率（△D%）呈负相关;与左室收缩末内径（LVSd）、左室舒张末内径（LVDd）呈正相关.[结论] 在患者心力衰竭的进展中其血浆BNP水平与心衰程度密切相关,测定患者血浆BNP水平是监测心衰程度的有效手段之一.     

老年心力衰竭患者甲状腺激素和血浆N末端原脑钠肽的变化及其与预后的关系

目的探讨老年慢性心力衰竭患者心功能与血清甲状腺激素、血浆N末端原脑利钠肽(NT-proBNP)的变化及对预后的影响。方法选择60例老年慢性心力衰竭患者,根据NYHA心功能Ⅱ、Ⅲ、Ⅳ级分为2组,分别测定血NT-proBNP、血清三碘甲状腺原氨酸(T3),甲状腺素(T4),游离三碘甲状腺原氨酸(FT3),游离甲状腺素(FT4)及促甲状腺素(TSH)水平。比较2组间甲状腺激素变化及NT-proBNP变化。根据住院期间是否发生心血管事件(恶性心律失常、心衰反复或加重、心肌梗死、死亡)分为事件组和非事件组。结果心功能Ⅳ级患者与心功能Ⅱ级、Ⅲ级患者比较,T3和FT3明显降低,(P<0.05),NT-proBNP随着心功能不全加重而升高(P<0.05)。而T4、FT4、TSH均无明显变化(P>0.05)。心脏事件组与非事件组比较:NT-proBNP明显升高,T3和FT3明显降低,(P<0.05)。结论甲状腺激素、NT-proBNP与老年慢性心力衰竭患者的心功能严重程度有关,影响预后。     

Circulating natriuretic peptide concentrations in patients with end-stage renal disease: role of brain natriuretic peptide as a biomarker for ventricular remodeling.

OBJECTIVES: To determine levels of natriuretic peptides (NPs) in patients with end-stage renal disease (ESRD) and to examine the relationship of these cardiovascular peptides to left ventricular hypertrophy (LVH) and to cardiac mortality. PATIENTS AND METHODS: One hundred twelve dialysis patients without clinical evidence of congestive heart failure underwent plasma measurement of NP concentrations and echocardiographic investigation for left ventricular mass index (LVMI). RESULTS: Plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) concentrations correlated positively with LVMI and inversely with left ventricular ejection fraction, whereas C-type NP and Dendroaspis NP levels did not correlate with LVMI. In dialysis patients with LVH (LVMI >125 g/m2), plasma ANP and BNP concentrations were increased compared with those in dialysis patients without LVH (both P<001). In a subset of 15 dialysis patients without LVH or other concomitant diseases, plasma BNP concentrations were not significantly increased compared with those in 35 controls (mean +/- SD, 20.1+/-13.4 vs 13.5+/-9.6 pg/mL; P=.06), demonstrating that the BNP concentration was not increased by renal dysfunction alone. Furthermore, the BNP level was significantly higher in the 16 patients who died from cardiovascular causes compared with survivors (mean +/- SD, 129+/-13 vs 57+/-7 pg/mL; P<.003) and was significantly associated with greater risk of cardiovascular death in Cox regression analysis (P<.001), as was the ANP level (P=.002). CONCLUSIONS: Elevation of the plasma BNP concentration is more specifically related to LVH compared with the other NP levels in patients with ESRD independent of congestive heart failure. Thus, BNP serves as an important plasma biomarker for ventricular hypertrophy in dialysis patients with ESRD.     

Molecular cloning of hamster brain and atrial natriuretic peptide cDNAs. Cardiomyopathic hamsters are useful models for brain and atrial natriuretic peptides.

Brain and atrial natriuretic peptides (BNP and ANP) are cardiac hormones with diuretic, natriuretic, and vasodilatory activities. Cardiomyopathic hamsters are widely used animal models of heart failure. Due to the structural divergence of BNP among species, examination on pathophysiological roles of BNP using cardiomyopathic hamsters is so far impossible. We therefore isolated hamster BNP and ANP cDNAs, and investigated synthesis and secretion of these peptides in normal and cardiomyopathic hamsters. The COOH-terminal 32-residue peptide of cloned hamster preproBNP with 122 amino acids, preceded by a single arginine residue, supposedly represents hamster BNP showing < 50% homology to rat BNP. Alpha-hamster ANP, 28-residue peptide, is identical to alpha-rat ANP. In hamsters, BNP and ANP occur mainly in the ventricle and the atrium, respectively. The 32-wk-old hypertrophic cardiomyopathic BIO14.6 strain exhibited ventricular hypertrophy. The 32-wk-old dilated cardiomyopathic BIO53.58 strain remained at the stage without apparent heart failure. In BIO14.6 and BIO53.58 strains at this age, ventricular BNP and ANP gene expressions are augmented, and the plasma BNP concentration is elevated to 136 and 108 fmol/ml, respectively, three times greater than the elevated plasma ANP concentration, which well mimics changes of the plasma BNP and ANP concentrations in human heart failure. Cardiomyopathic hamsters, therefore, are useful models to investigate the implication of BNP in human cardiovascular diseases.     

Atrial natriuretic peptides: diagnostic and therapeutic potential

The natriuretic family consists out of three molecules that share significant amino acid sequence homologies and a looped motif. Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are similar in their abilities to promote natriuresis and diuresis, to inhibit the renin-angiotensin-aldosteroneaxis and to act as vasodilators. The understanding concerning the actions of the C-type natriuretic peptide is incomplete, but this new family member acts as a vasodilator. Plasma levels of ANP and BNP are elevated in patients with unstable angina, acute myocardial infarction, and with congestive heart failure. BNP may be superior to ANP as a prognosticator for risk stratification after myocardial infarction and is independent of left ventricular ejection fraction. ANP and BNP have little therapeutic potential while experimental work as well as clinical trials suggest that the inhibition of the catabolism of natriuretic peptides in particular in combination with ACE-inhibitors may be clinically beneficial.     

心功能不全多参数的相关性

目的探究患者心功能不全对血浆B型脑钠肽(BNP)水平与心功能分级、左室射血分数(EF)、P波终末电势(PtfV1)等多参数的相关性。方法对82例慢性心功能不全患者就诊后24 h内取静脉血测定血浆BNP,并行超声心动图、心电图检查,分析血浆BNP与NYHA心功能分级、EF、PtfV1之间的关系。结果心功能Ⅰ～Ⅳ级患者血浆BNP水平逐级增加(P0.05或P0.01);BNP与EF呈正相关,PtfV1值大的患者血浆BNP水平显著高于PtfV1值小的患者,BNP与PtfV1、心功能分级呈正相关。结论血浆BNP水平与传统的评价心功能指标有明确相关性,可作为临床评价心功能状况的良好指标;床边心电图PtfV1≥0.03 mm.s可作为左心功能不全评估的初步依据。     

The circulating levels of cardiac natriuretic hormones in healthy adults: effects of age and sex.

In order to study the relationships between sex hormones, aging, and circulating levels of cardiac natriuretic peptides and to define reference values for atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) assays, we measured the plasma levels of cardiac natriuretic peptides in a large group of healthy adults divided according to age and sex. We studied 216 healthy subjects of both sexes (109 men and 107 women) with age ranging from 20 to 77 years (mean 43.2+/-14.8 years). All subjects were non-obese and had normal arterial blood pressure; they were free from acute diseases, including asymptomatic heart disease. Highly sensitive and specific IRMA methods were used to measure plasma ANP and BNP. The mean ANP value in healthy adult subjects of both sexes was 17.8+/-10.9 pg/ml with no significant difference between men (16.7+/-10.0 pg/ml) and women (18.8+/-11.7 pg/ml). The mean BNP value in healthy adult subjects of both sexes was 9.9+/-9.0 pg/ml with a significant difference (p<0.0001) between men (7.7+/-7.1 pg/ml) and women (12.2+/-10.2 pg/ml). There was a weak linear relationship between age and either ANP (r=0.350, p<0.0001) or BNP (r=0.254, p=0.0002) values. When the circulating levels of cardiac natriuretic hormones, and age and sex were analyzed by multiple stepwise regression analysis, both age and sex significantly and independently contributed to the regression. Our study indicates independent positive effects of aging and female sex hormones on ANP and BNP levels in healthy adult subjects. These effects should be taken into account in the calculation of appropriate reference values for cardiac natriuretic hormones.     

Effects of posture and saline infusion on atrial natriuretic peptide and haemodynamics in patients with Bartter''s syndrome and healthy controls

In order to explore the role of atrial natriuretic peptide (ANP) in Bartter's syndrome, five patients and five healthy controls matched for age and sex were studied. The study was designed to stimulate and suppress ANP secretion by manipulation of right atrial pressure with different body positions and mild volume expansion with saline. Other vasoactive hormones were also measured, and heart rate and blood pressure were recorded at 5-min intervals. Plasma ANP levels increased after head-down tilt and returned to baseline in the upright position. Infusion of saline failed to increase plasma ANP both in the control group and in four of the patients. No significant differences were found in plasma atrial natriuretic peptide concentrations between both groups. In view of previously reported elevated plasma ANP levels, Bartter's syndrome may be heterogeneous in this respect. Plasma renin activity was higher in the patients, but plasma aldosterone, adrenaline and noradrenaline were similar in both groups. Mean arterial blood pressure was similar in both groups, but rose significantly in the upright position in the control group only, while changes in heart rate were similar in both groups. We conclude that atrial natriuretic peptide does not seem to play a causal role in our patients with Bartter's syndrome.     

Influence of ScaI and natriuretic peptide (NP) clearance receptor polymorphisms of the NP System on NP concentration in chronic heart failure

BACKGROUND: Genetic variants related to the natriuretic peptide (NP) system [ScaI mutated allele (A1) of the atrial NP (ANP) gene and the C variant of the natriuretic peptide clearance receptor (NPRC) gene] have been identified as independent risk factors for cardiovascular morbidity and mortality. Despite the importance of NPs in heart failure (HF), the role of these polymorphisms in HF has not been evaluated. METHODS: We screened 124 HF patients [mean (SD), age 66 (12) years, 100 men, ejection fraction 32% (10%), New York Heart Association (NYHA) class I-II 65, III-IV 59] for NP concentrations [ANP, brain NP (BNP) and amino-terminal pro-BNP (NT-proBNP)] and for the ScaI and NPRC variants. RESULTS: ScaI polymorphism had no effect on NP concentration in the NYHA I-II subgroup. Conversely, in severe HF, A1 carriers had higher ANP (P < or =0.05), BNP (P <0.01), and NT-proBNP (P <0.01) than A2A2 patients. After multivariate adjustment, A1 presence remained an independent predictor for increased NP. Regarding NPRC polymorphism in mild HF, higher ANP (P <0.05) and BNP (P <0.05) were observed in CC than A allele carriers. After multivariate adjustment, however, this association did not remain significant. In severe HF, the NPRC polymorphism had no effect on NP. CONCLUSIONS: The ScaI polymorphism of the ANP gene might be an important additive genetic factor influencing neurohormonal activation and disease progression in severe HF. The NPRC polymorphism is not an independent determinant of NP concentration in HF.     

血浆BNP在慢性心功能不全诊断和治疗中的应用

目的 观察慢性心功能不全患者血浆BNP和左心室EF水平的相关性及不同心功能分级的心衰患者经过治疗症状缓解后上述指标的变化。 方法 按美国NYHA心功能分级标准，随机抽取心功能Ⅰ级、Ⅱ级、Ⅲ级及Ⅲ级以上心内科住院病人各30例，采用美国博适（Bzosite Triagoe）BNP快速定量诊断仪Elisa法测定血浆BNP的含量，使用日本东芝心脏彩超测定左室射血分数（EF），慢性心功能不全（Ⅱ级及以上心功）患者经常规治疗症状缓解后同法测上述指标，数据采用SPSS10.0统计分析软件分析。结果 血浆BNP水平与EF呈负相关（r=-0.79 p=0.032），不同心功能分级患者的血浆BNP水平差异具统计学意义而EF差异仅在Ⅰ、Ⅲ级心功能间有意义（ p＜0.05），经抗心衰治疗后，患者心衰症状缓解，BNP含量下降而EF升高，但仅BNP的变化有统计学意义。结论 血浆BNP水平是慢性心功能不全诊断、治疗疗效评价的敏感指标。     

心力衰竭患者脑型利钠肽与心功能和运动呼吸困难程度的关系

目的心力衰竭患者经常有心率增快和舒张功能异常,运动性呼吸困难是许多心脏病患者常见表现,本研究探讨心力衰竭患者血浆脑型利钠肽（BNP）水平与心脏功能参数及呼吸困难严重程度等因素的关系。方法对32例心力衰竭患者（心力衰竭组）进行多普勒超声心动图及血浆BNP和心房利钠肽（ANP）检测,并与30例心功能正常的健康成年人（对照组）的相同指标进行比较。另外,21例患者进行心肺运动试验,观察运动高峰BNP与心肺运动试验VE/VCO2斜率相关性。结果32例心力衰竭患者,其中18例为缺血性心脏病,14例扩张型心肌病,静态心率明显高于正常对照组（P〈0.05）,心力衰竭组左室内径明显增加（P〈0.05）,短轴缩短率明显异常（P〈0.05）。左房内径无明显增加,左室射血距离减低（P〈0.05）,舒张早期充盈速度无明显差别。心力衰竭组BNP水平[（13±11）pmol/L],较对照组[（4.6±2.1）pmol/L]明显增加（P〈0.05）。BNP与ANP水平呈正相关（r=0.73,P〈0.01）。心脏内径大小对BNP和ANP无明显影响。BNP水平与心率、射血时间、充盈时间、E/A比值明显相关,相关系数分别为-0.67、0.71、-0.41、0.62（P均〈0.01）,与左室内径和心房内径无相关性。ANP水平只与E/A比值高度相关（r=0.55,P〈0.05）。运动高峰BNP浓度与VE/VCO2斜率正相关（r=0.70,P〈0.01）。结论在心力衰竭患者中,血浆BNP水平能较好地反映心力衰竭患者的多普勒超声心动图心功能参数及运动呼吸困难程度的状况。     

Plasma atrial natriuretic peptide and brain natriuretic peptide are increased in septic shock: impact of interleukin-6 and sepsis-associated left ventricular dysfunction

Objective Interest has recently focused on the use of neurohormonal markers such as atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) as indices of left ventricular systolic dysfunction and prognosis in heart failure. Also, peptides belonging to the interleukin-6 (IL-6) family have been shown to induce ANP and BNP secretion. We hypothesized that BNP and ANP spillover in the peripheral circulation reflects left ventricular dysfunction and IL-6 production in septic shock.Design and setting Retrospective, clinical study in the medical intensive care unit of a university hospital.Patients and participants 17 patients with septic shock and 19 control subjects.Interventions Collection of clinical and demographic data in relation to ANP, BNP, IL-6, and soluble TNF receptors (sTNF-R-p55, sTNF-R-p75) in plasma over a period of 4 days.Measurements and results In septic shock we found a significant increase in ANP (82.7±9.9 vs. 14.9±1.2 pg/ml) and BNP (12.4±3.6 vs. 5.5±0.7 pg/ml). Plasma ANP peaked together with IL-6. Peaks of ANP and IL-6 were significantly correlated (r=0.73; p<0.01). BNP was inversely correlated to cardiac index (r=–0.56; p<0.05).Conclusions ANP and BNP increase significantly in patients with septic shock. BNP reflects left ventricular dysfunction. ANP is related to IL-6 production rather than to cardiovascular dysfunction.     

心脉隆注射液对PCI围手术期心力衰竭患者疗效观察

目的:通过观察经皮冠状动脉介入治疗(Percutaneous Coronary Intervention,PCI)围手术期心力衰竭患者左室射血分数(Left Ventricular Ejection Fraction,LVEF)、血浆N端B型脑钠肽(N-terminal Brain Natriuretic Peptide,NT-pro BNP)水平、左室舒张末期内径(Left Ventricular and Diastolic Diameter LVDD)及6 min步行距离变化,探讨心脉隆注射液对PCI围手术期心力衰竭患者临床疗效。方法:将100例行PCI治疗且围手术期出现心力衰竭的患者随机分为对照组和治疗组,每组50例。两组均给予常规治疗,治疗组在常规治疗的基础上加用心脉隆注射液6 ml+0.9%氯化钠溶液200 ml静脉滴注,2次/d,疗程10 d。通过测定治疗前、治疗10 d后LVEF、LVDD、血浆NT-pro BNP水平比较两组治疗效果。结果:两组治疗后左室射血分数较治疗前明显升高,差异具有统计学意义(P0.05),且治疗组改善程度高于对照组,差异也具有统计学意义(P0.05);两组治疗后LVDD、NT-pro BNP较治疗前明显下降,差异具有统计学意义(P0.05),且治疗10 d后,治疗组LVDD、NT-pro BNP下降程度高于对照组(P0.05);1个月后治疗组6 min步行距离较对照组远,差异具有统计学意义(P0.05)。结论:心脉隆注射液可明显改善PCI围手术期心力衰竭患者心功能,显著降低血浆NT-pro BNP水平。     

心力衰竭患者血浆心钠素水平与左心功能关系的临床研究

目的:探讨血浆心钠素(ANP)水平与心力衰竭患者临床心功能变化之间的关系.方法:采用特异性放免法测定心衰患者血浆ANP水平,同时采用NYHA心功能分级和超声心动图检查评定患者左心功能.结果:随心功能恶化,血浆ANP水平呈上升趋势.各级心功间差异均有显著性意义(P＜0.05).经抗心衰药物综合治疗后,ANP水平降低(P＜0.01).ANP水平与左心室射血分数(LVEF)、左心室短轴缩短率(ΔD%)呈负相关;与左室收缩末内径(LVSd)、左室舒张末内径(LVDd)呈正相关.结论:心钠素在心力衰竭的进展中,其血中浓度与心衰程度密切相关,可用于监测心衰程度.