Utility of B-type natriuretic peptide (BNP) as a screen for left ventricular dysfunction in patients with diabetes

OBJECTIVE: Routine screening of diabetic patients with echocardiography is not feasible due to its limited availability and high cost. B-type natriuretic peptide (BNP) is secreted from the left ventricle in response to pressure overload and is elevated in both systolic and diastolic dysfunction. RESEARCH DESIGN AND METHODS: BNP levels were compared to echocardiographic findings in 263 patients. Patients were divided into two groups: clinical indication for echocardiography (CIE) (n = 172) and those without clinical indication for echocardiography (no-CIE) (n = 91). Cardiologists making the assessment of left ventricular function were blinded when measuring plasma levels of BNP. RESULTS: The 91 patients with no-CIE with echoes had similar BNP levels (83 +/- 16 pg/ml) to the 215 patients with no-CIE without echoes (63 +/- 10, P = 0.10). Patients with CIE and subsequent abnormal left ventricular function (n = 112) had a mean BNP concentration of 435 +/- 41 pg/ml, compared with those with no-CIE, but had abnormal left ventricular function on echo (n = 32) (161 +/- 40 pg/ml). Twenty-one of 32 patients with no-CIE but with abnormal left ventricular function had diastolic dysfunction (BNP 190 +/- 60 pg/ml). A receiver-operating characteristic (ROC) curve revealed that the area under the curve was 0.91 for CIE patients and 0.81 for no-CIE patients (P < 0.001). For those with no congestive heart failure (CHF) symptoms, BNP levels showed a high negative predictive value (91% for BNP values <39 pg/ml), while in those patients who had a CIE, BNP levels showed a high positive predictive value for the detection of left ventricular dysfunction (96% with BNP levels >90 pg/ml). CONCLUSIONS: BNP can reliably screen diabetic patients for the presence or absence of left ventricular dysfunction.     

腹型肥胖B型钠尿肽水平及其对评估慢性心功能不全的影响

【目的】探讨腹型肥胖患者血浆B型钠尿肽（BNP）水平及其对评估慢性心功能不全的影响。【方法】本院内科收治的慢性心功能不全患者158例,根据腰臀比（WHR）分为两组：腹型肥胖组（男性WHR≥0．85或女性WHR≥0．8）62例和非腹型肥胖组（男性WHR〈0．85或女性WHR〈0．8）96例;ELISA法测定血浆BNP浓度;超声心动图测定舒张末期室间隔厚度（IVST）、左室后壁厚度（LVPW）、左室舒张末内径（LVEDd）、舒张早期速度峰值（E）与舒张晚期速度峰值（A）的比值（E／A）和左室射血分数（LVEF）;比较两组血浆BNP水平及超声心动图测量结果、以BNP100pg／mL为切点评估心脏功能时的诊断敏感性;将血浆BNP测定值进行对数转换后,与BMI进行线性回归分析。【结果】腹型肥胖纽中血浆BNP水平（306．88±225．46pg／mL）明显低于非腹型肥胖组[（548．31±353．22）pg／mL,P〈0．051;以BNP100pg／mL为切点,对心脏舒张功能不全的诊断敏感性腹型肥胖组（83．3％）低于非腹型肥胖组（93．1％）,对心脏收缩功能不全的诊断敏感性腹型肥胖组（90．0％）低于非腹型肥胖组（97．4％）,但降低程度均无显著性差异（P〉0．05）;LogBNP与BMI之间存在负相关（r=-0．276,P〈0．05）。【结论】腹型肥胖会影响血浆BNP水平,BMI与血浆BNP呈负相关,对腹型肥胖患者进行心功能评价时应考虑‘该因素的影响。     

舒张性与收缩性心力衰竭血浆脑钠肽和N末端脑钠肽前体的研究

目的：探讨心力衰竭患者心肌应激标志物血浆N末端脑钠肽前体（Nt-pro-BNP）、血浆脑钠肽（BNP）水平的变化,及其对收缩性心力衰竭（SHF）与舒张性心力衰竭（DHF）的鉴别意义。方法选择心力衰竭的患者115例,其中SHF组68例、DHF组47例,另选健康体检者56例作为对照组。测定三组间血浆Nt-pro-BNP、BNP和左心室射血分数（LVEF）。结果三组患者的BNP、Nt-Pro-BNP和LVEF比较,差异均有统计学意义（F分别=157.34、189.98、102.23,P均＜0.05）,且SHF组和DHF组的BNP和Nt-Pro-BNP水平明显高于对照组,差异均有统计学意义（t分别=21.67、31.02、22.67、31.82,P均＜0.05）,SHF组的BNP和Nt-Pro-BNP水平明显高于DHF组,差异均有统计学意义（t分别=18.45、24.67,P均＜0.05）。SHF组的LVEF水平明显低于DHF组和对照组,差异均有统计学意义（t分别=17.56、23.59,P均＜0.05）,但DHF组和对照组的LVEF水平比较,差异无统计学意义（t=2.89, P＞0.05）。 BNP、Nt-pro-BNP鉴别DHF和SHF的受试者工作特征曲线（ROC）曲线下面积分别为0.74和0.77,BNP＞150 pg/ml、Nt-pro-BNP＞500 pg/ml作为界值的灵敏度分别为71.32％和74.58％,特异度为62.35％和73.28％。结论血浆BNP和Nt-pro-BNP对鉴别DHF和SHF可能有一定帮助,当心衰患者血清BNP＞150 pg/ml、Nt-pro-BNP＞500 pg/ml时,患者诊断为SHF的可能性大。     

B-type natriuretic peptide levels in patients with COPD and normal right ventricular function

INTRODUCTION: Evidence suggests that elevated plasma levels of B-type natriuretic peptide (BNP) are found in patients with chronic obstructive pulmonary disease (COPD) and right ventricular dysfunction. We examined the effects of exercise on plasma BNP levels in patients with COPD who have normal right ventricular function METHODS: Seventeen patients with a diagnosis of COPD and normal right ventricular function demonstrated by radionuclide ventriculography, and 17 age-and sex-matched healthy subjects underwent a treadmill exercise test. Plasma BNP levels were measured sequentially before, immediately after, and 1 hour after the exercise test RESULTS: The mean plasma BNP+/-standard deviation levels of the COPD and control groups before exercise were 21.3+/-16 pg/ml and 13.4+/-11 pg/ml, respectively (P>0.05). Mean plasma BNP level measured immediately after exercise was 37.9+/-31 pg/ml in the COPD group, reflecting a statistically significant increase when compared with the initial value (P<0.05). The control group did not show any significant change in plasma BNP levels after the exercise test CONCLUSIONS: Exercise induces an increase in plasma BNP levels in patients with COPD who do not have right ventricular dysfunction at rest. Measurement of exercise-induced BNP levels may be a useful alternative to pulmonary artery catheterisation in identifying the patients who are likely to benefit from long-term oxygen therapy.     

Natriuretic peptides and the prevalence of congestive heart failure in patients with pacemakers

AIM: The aim of the study was to investigate the diagnostic potential of natriuretic cardiac peptide measurement in the context of left ventricular dysfunction and comorbidities in a pacemaker population. MATERIAL AND METHODS: Ninety-five consecutive patients with pacemakers were included in the study. All patients underwent echocardiography and were asked to complete the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Brain natriuretic peptide (BNP), N-terminal proatrial natriuretic peptide (N-ANP) and atrial natriuretic peptide levels in plasma were measured. RESULTS: Twenty-six percent of patients had reduced systolic left ventricular function; only 16 patients had a history of congestive heart failure. BNP was abnormally elevated in 64%, N-BNP in 72% and N-ANP in 96% of patients. Both BNP (r = 0.30; P < 0.01) and N-ANP (r = 0.39; P < 0.0005) correlated with MLHFQ. The strongest correlation was found between N-ANP and the ejection fraction (r = 0.6; P < 0.0001). Patients were stratified in a high-risk group and a low risk-group according to their N-ANP (N-ANP > 5000 fmol L(-1); n = 63 and N-ANP < 5000 fmol L(-1), n = 32) and BNP levels (BNP > 400 pg mL(-1); n = 17 and BNP < 400 pg mL(-1), n = 78). N-ANP was correlated with hypertension (P < 0.003) and atrial fibrillation (P < 0.03), and BNP with mitral insufficiency (P < 0.002). CONCLUSIONS: Cardiac natriuretic peptides are markedly elevated in the majority of patients with pacemakers. The prognostic significance of BNP and N-ANP in left ventricular dysfunction warrants close follow-up schedules.     

老年舒张性心力衰竭患者血清促甲状腺激素与B型利钠肽的关系

目的探讨老年舒张性心力衰竭(DHF)患者血清促甲状腺激素(TSH)与B型利钠肽(BNP)的关系。方法93例老年舒张性心力衰竭患者同时测定血清TSH和BNP浓度。结果TSH升高（>5.5 μIU/ml)患者(n=46)血清BNP为（1011.07±238.27） pg/ml,高于TSH正常(0.35～5.5 μIU/ml)的患者(n=47)（769.36±169.55） pg/ml（P<0.05）。结论老年舒张性心衰伴TSH升高患者,血清BNP升高更明显。     

氨基末端脑利钠肽前体对无症状性心功能不全诊断价值的研究

【目的】探讨无症状性心功能不全患者氨基末端脑利钠肽前体（NT-proBNP）血浆浓度的变化规律,为早期诊断心功能不全提供依据。【方法】选择在本院住院无心功能不全症状的高危者120例作为研究对象,检测其NT—proBNP浓度,依据NT-proBNP水平将120例受试者分为NT—proBNP升高组（试验组）和NT-proBNP正常组（对照组）,并进行心脏彩色多普勒超声检查,测定其左室射血分数（LVEF）、舒张早期心室最大充盈速度／舒张晚期心室最大充盈速度（E／A）、左室舒张末期内径（LVEDD）、室间隔厚度（IVST）、左室后壁厚度（LVPWT）、左室短轴缩短分数（FS）,对两组样本各项心功能指标进行比较分析,并对NT—proB—NP水平和各项心功能指标进行相关性分析。【结果】试验组左室收缩功能和舒张功能各指标均较对照组差（P〈0．05）,提示存在心功能不全。【结论】无症状人群血浆NT—proBNP浓度升高提示心功能不全,NT—proBNP可作为心功能不全的早期诊断依据之一,其升高程度与心功能受损程度呈正相关。     

Determinants of the reduction in B‐type natriuretic peptide after mitral valve replacement in patients with rheumatic mitral stenosis

Background: Plasma B‐type natriuretic peptide (BNP) levels are closely related to symptoms in left ventricle (LV) systolic heart failure, although marked regarding heterogeneity levels among subjects are reported. Aims: To assess the influence of right ventricle on plasma BNP in the patients with different grades of its overload secondary to severe mitral valve stenosis (MVS). Methods: Plasma BNP was evaluated in MVS patients (n = 27) before valve replacement and during follow‐up (FUV) 401 ± 42 days after operation. Results: Initial examination showed severe MVS (0.9 ± 0.2 cm²), left atrial enlargement (LAI 30 ± 4.5 mm m^?2), right ventricle diastolic dilatation (RVDI 16 ± 3.6 mm m^?2), normal LV size/function and elevated BNP levels (166 ± 137 pg ml^?1). FUV examination revealed a significant reduction in LAI (27 ± 2.2 mm m^?2), RVDI (14 ± 1.6 mm m^?2) and BNP levels (80 ± 35 pg ml^?1). The regression analysis of the initial parameters found RVDI to be the strongest predictor (R² = 0.61; P<0.0001) for BNP level, whereas RVDI reduction was the strongest factor for BNP decrease (R² = 0.65; P<0.0001) during FUV. Conclusions: Right ventricle should be taken into account as a potential important source of plasma BNP owing to the fact that LV size and function are well preserved in MVS patients. RVDI determines BNP plasma levels whereas after MVS removal, the RVDI reduction predicts BNP level decrease.     

Effect of right ventricular apex pacing on the Tei index and brain natriuretic peptide in patients with a dual-chamber pacemaker

BACKGROUND: Asynchronous electrical activation induced by right ventricular apex (RVA) pacing can cause various abnormalities in left ventricular (LV) function, particularly in the context of severe LV dysfunction or structural heart disease. However, the effect of RVA pacing in patients with normal LV and right ventricular (RV) function has not been fully elucidated. The aim of this study was to characterize the effects of RVA pacing on LV and RV function by assessing isovolumic contraction time and isovolumic relaxation time divided by ejection time (Tei index) and by assessing changes in plasma brain natriuretic peptide (BNP). METHODS: Doppler echocardiographic study and BNP measurements were performed at follow-up (mean intervals from pacemaker implantation, 44+/-75 months) in 76 patients with dual chamber pacemakers (sick sinus syndrome, n=30; atrioventricular block, n=46) without structural heart disease. Patients were classified based on frequency of RVA pacing, as determined by 24-hour ambulatory electrocardiogram (ECG) that was recorded just before echocardiographic study: pacing group, n=46 patients with RVA pacing>or=50% of the time, percentage of ventricular paced 100+/-2%; sensing group, n=30, patients with RVA pacing<50% of the time, percentage of ventricular paced 3+/-6%. RESULTS: There was no significant difference in mean heart rate derived from 24-hour ambulatory ECG recordings when comparing the two groups (66+/-11 bpm vs 69+/-8 bpm). LV Tei index was significantly higher in pacing group than in sensing group (0.67+/-0.17 vs 0.45+/-0.09, P<0.0001), and the RV Tei index was significantly higher in pacing group than in sensing group (0.34+/-0.19 vs 0.25+/-0.09, P=0.011). Furthermore, BNP levels were significantly higher in pacing group than in sensing group (40+/-47 pg/mL vs 18+/-11 pg/mL, P=0.017). With the exception of LV diastolic dimension (49+/-5 mm vs 45+/-5 mm, P=0.012), there were no significant differences in other echocardiographic parameters, including left atrium (LA) diameter (35+/-8 mm vs 34+/-5 mm), LA volume (51+/-27 cm3 vs 40+/-21 cm3), LV systolic dimension (30+/-6 mm vs 29+/-7 mm), or ejection fraction (66+/-9% vs 63+/-11%), when comparing the two groups. CONCLUSIONS: These findings suggest that the increase of LV and RV Tei index, LVDd, and BNP are highly correlated with the frequency of the RVA pacing in patients with dual chamber pacemakers.     

Pacemaker implantation as a risk factor for heart failure in young adults with congenital heart disease

AIM: Complete postoperative heart block following open-heart surgery and sinus node dysfunction are indications for permanent cardiac pacing in children with congenital heart defects. The purpose of our study was to evaluate if cardiac pacing is a risk factor of heart failure during longtime follow-up of grown ups with congenital heart disease (GUCH). METHODS: For an objective assessment of heart failure, NT-Pro brain natriuretic peptide (BNP) and maximal oxygen uptake index (VO2max) during the cardiopulmonary exercise testing were measured in 346 consecutive GUCH patients during a longtime follow-up examination. RESULTS: Thirty-nine of these patients who had pacemaker implantation had significantly increased BNP levels (448.2 +/- 76.8 vs 123.8 +/- 9.7 pg/mL, P < 0.0001) and significantly decreased VO(2max) (22.5 +/- 0.9 vs 27.4 +/- 0.4, P < 0.0001). Heart failure in pacemaker patients was associated with significantly prolonged QRS complex durations (171.1 +/- 8.3 ms vs 108.7 +/- 1.8 ms, P < 0.0001), increased right ventricular end diastolic diameters (38.7 +/- 2.1 mm vs 27.8 +/- 0.5mm, P < 0.0001), lower heart rates at rest (69.5 +/- 1.9/min vs 82 +/- 1/min, P < 0.0001), and at exercise (140.3 +/- 5.8/min vs 163.5 +/- 1.2/min, P < 0.0001). Mean fractional shortening of the left ventricle was normal in both patient groups. CONCLUSION: Pacemaker implantation may be associated with heart failure during longtime follow-up of GUCH indicated by significantly elevated BNP levels and decreased VO2max. Possible explanations are prolongation of QRS complex duration, decreased maximal heart rates during exercise, and dilatation of the right ventricle.     

脑钠肽在左心功能不全诊断中的检测及临床价值

目的 探讨检测血浆脑钠肽(BNP)在诊断左心功能不全中的价值.方法 用微粒子酶免疫法(MEIA)检测96例左心功能不全患者的血浆BNP水平,同时用心脏彩色多普勒超声仪检查左心室射血分数(LVEF),分析BNP与心功能分级以及LVEF的相关性.结果 96例左心功能不全患者BNP及LVEF分别为(627.26±358.47)pg/mL、(58.52±8.35)％,二者呈负相关关系.心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级患者BNP水平分别为(127.32±38.40)、(487.08±308.68)、(1206.10±575.10)、(1603.31±647.62) pg/mL,血浆BNP水平与心功能分级呈正相关.结论 血浆BNP检测可减少心脏彩超对左心功能不全诊断的漏诊率,是心力衰竭诊断、疗效观察、预后评估的理想指标.     

Beneficial effect of beta-adrenergic blockade on left ventricular function in haemodialysis patients

Congestive heart failure is a common and serious complication in patients undergoing chronic dialysis. However, there have been no studies on preferential medical therapies to improve left ventricular function in haemodialysis patients. Beta-blocker treatment is known to improve left ventricular function in patients with dilated cardiomyopathy; moreover, plasma levels of noradrenaline and natriuretic peptides are sensitive markers of left ventricular dysfunction. The present study investigated whether beta-blocker treatment could improve left ventricular function in haemodialysis patients with a dilated left ventricle. Our study group comprised 14 haemodialysis patients with a dilated left ventricle, who had undergone maintenance haemodialysis for a mean of 11 years. The following haemodynamic parameters were evaluated before and after 4 months of treatment with the beta-blocker metoprolol: left ventricular dimension at end-systole and end-diastole, and fractional shortening. Plasma levels of noradrenaline, atrial natriuretic peptide and brain natriuretic peptide were also determined. Dry body weight and haemoglobin concentration showed no significant change after compared with before treatment with metoprolol. Heart rate decreased significantly, from 79+/-9 beats/min to 69+/-9 beats/min, but systolic blood pressure remained unchanged. The left ventricular dimension both at end-systole and at end-diastole was decreased, and fractional shortening increased significantly. Plasma levels of noradrenaline did not change significantly, but those of atrial natriuretic peptide and brain natriuretic peptide decreased markedly [from 100+/-89 pg/ml to 46+/-29 pg/ml (P=0.0051) and from 549+/-516 pg/ml to 140+/-128 pg/ml (P=0.0035) respectively]. In conclusion, beta-blocker therapy with metoprolol can markedly attenuate left ventricular remodelling and decrease the plasma levels of natriuretic peptides in haemodialysis patients with a dilated left ventricle.     

Contribution of plasma matrix metalloproteinases to development of left ventricular hypertrophy and diastolic dysfunction in hypertensive subjects

Matrix metalloproteinases (MMPs) are involved in the regulation of the extracellular matrix (ECM) of the myocardium and thus the pathogenesis of vascular and cardiac hypertrophy. In this study, we investigated contribution of plasma matrix metalloproteinases to development of left ventricular hypertrophy (LVH) and diastolic dysfunction in hypertensive subjects. Hypertensive patients with (n = 27) and without LVH (n = 23) were included. All participants underwent a complete transthoracic echocardiographic examination, including recordings of the mitral annular early, late, systolic and diastolic velocities by Doppler imaging. Plasma concentrations of MMP-3 and MMP-9 were determined by the one-step sandwich enzyme immunoassay method. Plasma MMP-3 and MMP-9 concentrations were significantly higher in patients with LVH than those without LVH (2.4 +/- 1.2 vs 1.5 +/- 0.7 ng/ml, p = 0.006 and 5.2 +/- 2.8 vs 3.3 +/- 1.7 ng/ml, p = 0.003, respectively). MMP-3 and MMP-9 levels were also correlated with left ventricular posterior wall thickness and Doppler indices of diastolic dysfunction. Our findings have suggested that increased MMP levels may contribute to LVH and left ventricular diastolic dysfunction. Therefore, treatment of hypertension with MMP lowering drugs, such as angiotensin converting enzyme inhibitors and angiotensin receptor blockers, may have favorable effects on LVH and left ventricular diastolic dysfunction.     

Assessment of brain natriuretic peptide in patients with suspected heart failure: comparison with radionuclide ventriculography data

BACKGROUND: The aim of the study was to prospectively evaluate patients with suspected or known heart disease using plasma brain natriuretic peptide (BNP) measurement and radionuclide ventriculography to examine whether left ventricular dysfunction is associated with an abnormal rise of BNP concentration. METHODS: Patients (n=153) and controls (n=14) underwent radionuclide ventriculography to determine Left ventricular Ejection Fraction (LVEF) and measurement of plasma BNP concentration using a commercial kit. RESULTS: Plasma BNP concentration in controls was significantly lower than that in patients whatever the stage of the disease, significantly lower than that of patients with normal LVEF (LVEF>55%); than that of patients with altered LVEF (LVEF< or =40%); and than that of patients with moderately reduced LVEF (40%相似文献   

Correlation of the myocardial performance index with plasma B-type natriuretic peptide levels in patients with mitral regurgitation

Objective The Myocardial performance index (MPI) is an echocardiographic index of combined systolic and diastolic function, calculated as isovolumetric relaxation time plus isovolumetric contraction time divided by ejection time. The aim of this study was to define the correlation of the MPI with plasma B-type natriuretic peptide (BNP) levels and echocardiographic parameters in patients with chronic mitral regurgitation (MR). Methods About 33 patients with at least moderate MR of organic etiology were enrolled to the study. All patients undergone complete 2D and Doppler echocardiography. Plasma BNP levels were studied. Results BNP levels in NYHA classes I–III were 9.3 ± 2.2 pg/ml, 61.3 ± 12.2 pg/ml, and 199.6 ± 55.2 pg/ml, respectively (I vs. II P < 0.001, I vs. III P < 0.001 and II vs. III P = 0.004). Myocardial performance index were 0.42 ± 0.02, 0.49 ± 0.02, and 0.52 ± 0.03 in MR patients with NYHA I–III, respectively. MPI was significantly higher in patients with NYHA class III compared to NYHA I (P = 0.001) and NYHA II (P = 0.005). There were no correlations between MPI and left atrial diameter, MR jet area, MR index and systolic pulmonary artery pressure whereas left ventricle (LV) end-systolic volume (r = 0.38), LV end-diastolic volume (LVDV) (r = 0.40), LV ejection fraction (r = −0.59), NYHA class (r = 0.51) and plasma BNP levels (r = 0.67) were strongly correlated. Only independent variable affecting MPI was plasma BNP level (odds ratio [CI]: 2.18[0.002−0.098], P = 0.041). Conclusions MPI is a powerful index in assessing the severity of left ventricular function and symptom severity in patients with MR. Plasma BNP is an independent predictor of MPI where both parameters assess combined systolic and diastolic LV function, effectively.     

B型钠尿肽在心功能评价及慢性充血性心力衰竭诊断中的应用价值

目的:研究B型钠尿肽(BNP)对心功能的评价作用及其在诊断慢性充血性心力衰竭中的应用价值。方法:选择慢性心衰患者152例,正常对照组48例,测定血清BNP浓度、LVEF等指标,分析其相关性。结果:心衰组BNP水平显著高于对照组(P<0.01),NYHA分级与BNP呈显著正相关(r=0.823,P<0.01),LVEF与BNP呈显著负相关(r=-0.652,P<0.01)。ROC曲线分析,BNP诊断心衰和左室收缩功能不全的诊断界值分别为100ng/L和580ng/L,此时诊断心衰和左室收缩功能不全的灵敏度和特异度分别为78%、98%和92.5%、88.5%;诊断心衰的阳性预测值为98%,阴性预测值为62%。结论:BNP可以客观准确评价心功能,对心衰及左室收缩功能不全的诊断具有理想的灵敏度和特异度,可作为诊断心衰的实验室指标之一,值得临床推广应用。     

B-type natriuretic peptide as an indicator of right ventricular dysfunction in acute pulmonary embolism

Objective: B‐type natriuretic peptide (BNP) is a neurohormone secreted from cardiac ventricles in response to ventricular strain. The aim of present study was to evaluate the role of BNP in the diagnosis of the right ventricular (RV) dysfunction in acute pulmonary embolism (PE). Methods: BNP levels were measured in patients with acute PE as diagnosed by high probability lung scan or positive spiral computed tomography. All patients underwent standard echocardiography and blood tests during the second hour of the diagnosis. Results: Forty patients diagnosed as acute PE (mean age, 60.4 ± 13.2 years; 62.5% women) were enrolled in this study. Patients with RV dysfunction had significantly higher BNP levels than patients without RV dysfunction (426 ± 299.42 pg/ml vs. 39.09 ± 25.22 pg/ml, p < 0.001). BNP‐discriminated patients with or without RV dysfunction (area under the receiver operating characteristic curve, 0.943; 95% CI, 0.863–1.022). BNP > 90 pg/ml was associated with a risk ratio of 165 (95% CI, 13.7–1987.2) for the diagnosis of RV dysfunction. There was a significant correlation between RV end‐diastolic diameter and BNP (r = 0.89, p < 0.001). Sixteen patients (40%) were diagnosed as having low‐risk PE, 19 patients (47.5%) with submassive PE and five patients (12.5%) with massive PE. The mean BNP was 39.09 ± 25.2, 378.4 ± 288.4 and 609.2 ± 279.2 pg/ml in each group respectively. Conclusion: Measurement of BNP levels may be a useful approach in diagnosis of RV dysfunction in patients with acute PE. The possibility of RV dysfunction in patients with plasma BNP levels > 90 pg/ml should be strongly considered.     

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.     

Permanent and atrial-synchronized ventricular stimulation for clinically stable patients with normal or impaired left ventricular systolic function

BACKGROUND: Ventricular desynchronization imposed by permanent dual-chamber ventricular pacing (VDD) may compromise ventricular function. METHODS: We investigated the impact of background VDD pacing on the right and left ventricular (LV) function on 129 clinically stable outpatients (mean age 69 +/- 10) implanted chronically with a dual-chamber pacemaker or an automatic defibrillator by using echocardiographic techniques including tissue doppler imaging (TDI) and color M-mode (CMM) examinations, and B-type natriuretic peptide (BNP) measurements. Patients were divided into two groups of normal (n = 65) or impaired (n = 64) LV systolic function (ejection fraction 63 +/- 6% and 38 +/- 10%, respectively) according to clinical and echocardiographic criteria. Each patient group included two subgroups on the basis of the underlying permanent and atrial-synchronized heart rhythm: either intrinsic ventricular activation (IVA) or VDD pacing. RESULTS: The BNP levels (mean, 95% CI) of patients with impaired LV systolic function were approximately threefold higher than those of patients with normal LV systolic function [189 (145-245) pg/mL vs 65 (50-85) pg/mL, P < 0.0001], but did not differ between subgroups of patients with IVA vs VDD pacing. By two-way analysis of variance and analysis of covariance, and after adjustment for age and gender, significant VDD pacing effects were found in terms of lower E/A ratio (P < 0.05) and increased LV end-systolic volume (P < 0.05). VDD pacing did not significantly affect the BNP levels and the LV filling pressures, as determined by the E/Ea and E/Vp ratios. CONCLUSIONS: Long-term VDD pacing may not be harmful in clinically stable patients with normal or moderately reduced LV systolic function.     

高血压病患者心脏结构及功能变化与心房颤动关系的研究

目的:评价高血压病患者合并不同类型心房颤动(房颤)时心脏结构及功能变化特点。方法:入选高血压病不伴房颤75例(A组)、伴阵发性房颤30例(B组)、伴持续或永久性房颤20例(C组)。所有患者均行24h动态心电图检查判定心律失常情况,多普勒超声心动图检查评价心脏结构和功能,同时用干式快速免疫荧光法定量测定血浆B型钠尿肽(BNP)浓度,协助评估心功能。结果:(1)3组间,C组的左心房内径(LAD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左室收缩末期内径(LVESd)、左室舒张末期内径(LVEDd)、左室质量指数(LVMI)、左心室室壁相对厚度(RWT)、血浆BNP浓度最大,左室射血分数(LVEF)最低,且均与其他2组有统计学差异(P<0.05);(2)B组的LAD、IVST、LVPWT、LVESd、LVEDd、LVMI、RWT、LVEF、血浆BNP浓度大于A组,但仅LAD、LVMI、血浆BNP浓度达统计学差异(P<0.05)。结论:高血压病患者合并房颤时左心结构及功能发生明显变化,且以合并持续或永久性房颤时最显著。