Plasma levels of tumor necrosis factor-alpha correlate with the six-minute walk test results in patients with mild to moderate heart failure.

BACKGROUND: The plasma levels of brain natriuretic peptide, tumor necrosis factor-alpha, big endothelin-1 and cardiac troponins have been reported to correlate with the severity of heart failure. METHODS: In a single population of 80 outpatients with mild to moderate chronic heart failure the correlation between the patient's functional capacity, as evaluated at a 6-min walk test, the clinical parameters and plasma levels of brain natriuretic peptide, tumor necrosis factor-alpha, big endothelin-1 and cardiac troponins was evaluated. RESULTS: A significant inverse correlation was found with the patient's age (p < 0.0001), NYHA functional class (p < 0.0001), left ventricular dysfunction etiology (ischemic vs dilated cardiomyopathy, p < 0.0005), heart rate (p < 0.05), plasma levels of brain natriuretic peptide (p < 0.05) and of tumor necrosis factor-alpha (p < 0.0005). At multiple regression analysis a correlation was found between the 6-min walk test results and the patient's age (p < 0.05), NYHA functional class (p < 0.01), left ventricular dysfunction etiology (ischemic vs dilated cardiomyopathy, p < 0.05) and tumor necrosis factor-alpha plasma levels (p < 0.05). CONCLUSIONS: In our patients with mild to moderate heart failure, a significant correlation was found between the results of the 6-min walk test and only the plasma concentrations of tumor necrosis factor-alpha among the laboratory parameters analyzed in this study.     

Activation of neurohumoral systems following acute myocardial infarction.

Previous studies have indicated that patients with an acute myocardial infarction have marked activation of all neurohumoral systems on admission to the hospital. This activation begins to subside within the first 72 hours so that by 7-10 days, all plasma neurohormones have returned to normal. The only documented exceptions were found to occur in patients with left ventricular dysfunction and overt heart failure, where both plasma renin activity and atrial natriuretic peptide were increased, and in patients with left ventricular dysfunction but no overt heart failure, where only atrial natriuretic peptide was increased. Although these studies suggest that neurohumoral activation rarely occurs at the time of hospital discharge, they were small and may have missed an important subgroup of patients with persistent neurohumoral activation. In the Survival and Ventricular Enlargement (SAVE) study, 522 patients had plasma neurohumoral levels measured at a mean of 12 days postinfarction. All SAVE patients had left ventricular dysfunction (left ventricular ejection fraction less than or equal to 40%), but no overt heart failure. In this group of patients, all neurohumoral levels (plasma renin activity, norepinephrine, arginine vasopressin, and atrial natriuretic peptide) were found to be increased compared with age-matched control subjects. These results indicate that, in fact, a subgroup of patients without overt heart failure has persistent neurohumoral activation at the time of hospital discharge postinfarction, and that this activation involves several neurohumoral systems. Since patients with persistent neurohumoral activation postinfarction are likely those most at risk of developing complications and the ones most likely to benefit from pharmacologic interventions blunting the effects of neurohumoral activation, measurement of predischarge neurohumoral levels may be useful.     

Plasma adrenomedullin, a new independent predictor of prognosis in patients with chronic heart failure.

BACKGROUND: Adrenomedullin, a potent endogenous vasodilating and natriuretic peptide, may play an important role in the pathophysiology of chronic heart failure. Plasma levels of immunoreactive adrenomedullin were examined for prediction of prognosis in chronic heart failure. METHODS AND RESULTS: Plasma levels of immunoreactive-ADM (ir-ADM) were measured by radioimmunoassay in 117 chronic heart failure patients with idiopathic or ischaemic cardiomyopathy (mean ejection fraction: 28 +/- 10%, in the NYHA functional class I/II/III/IV:8/73/29/7, and treated with ACE inhibitors and diuretics. Plasma levels of immunoreactive adrenomedullin were significantly increased in chronic heart failure patients by comparison to controls (618 +/- 293 pg x ml(-1) vs 480 +/- 135 pg x ml(-1), P=0.01). During the follow-up period (237 +/- 137 days) 14 cardiovascular deaths and four urgent cardiac transplantations occurred. In the univariate Cox model, immunoreactive adrenomedullin plasma levels were related to prognosis (P=0.004). A multivariate analysis including heart rate, systolic blood pressure, NYHA class, left ventricular ejection fraction, left ventricular echocardiographic end-diastolic diameter, plasma levels of immunoreactive adrenomedullin, endothelin-1, norepinephrine and atrial natriuretic peptide was performed: plasma levels of immunoreactive adrenomedullin (P=0.03), of endothelin-1 (P=0.0001), and systolic blood pressure (P=0.003) were significantly associated with outcome. CONCLUSION: Our results suggest that elevated plasma levels of immunoreactive adrenomedullin are an independent predictor of prognosis in predominantly mild to moderate chronic heart failure treated by conventional therapy and provide additional prognostic information.     

Use of cytosolic and myofibril markers in the detection of ongoing myocardial damage in patients with chronic heart failure

PURPOSE: Measurement of serum levels of cytosolic and myofibril components of cardiac tissue could indicate ongoing myocardial damage in patients with chronic heart failure. METHODS: We correlated serum levels of a cytosolic marker (heart-type fatty acid-binding protein) and a myofibril marker (troponin T) with the severity of symptoms (based on the New York Heart Association [NYHA] class), neurohumoral derangement, and subsequent cardiac events in 56 patients with chronic heart failure. RESULTS: Mean (+/- SD) levels of heart-type fatty acid-binding protein were greater in patients with NYHA class III or IV heart failure (9.9 +/- 5.2 ng/mL) than in those with NYHA class II (4.9 +/- 1.9 ng/mL, P <0.0001). Detection of troponin T (> or =0.02 ng/mL) was also more common in patients with worse heart failure (81% [13/16] in class III or IV vs. 43% [17/40] in class II, P = 0.02). Significant correlations were found between heart-type fatty acid-binding protein levels and plasma levels of A-type natriuretic peptide (r = 0.45, P = 0.0004), B-type natriuretic peptide (r = 0.66, P <0.0001), and norepinephrine (r = 0.36, P = 0.006). Male sex (hazard ratio [HR] = 5.0; 95% confidence interval [CI]: 1.3 to 19), detectable troponin T levels (HR = 7.0; 95% CI: 1.1 to 44), heart-type fatty acid-binding protein (HR = 2.6 per 3.9-ng/mL increase; 95% CI: 1.1 to 6.5), and left ventricular ejection fraction (HR = 3.6 per 15% decrease; 95% CI: 1.2 to 11) were independently associated with subsequent cardiac events (8 deaths or 10 readmissions because of worsening heart failure). CONCLUSION: Heart-type fatty acid-binding protein and troponin T are markers of ongoing myocardial damage, and are associated with subsequent cardiac events in patients with chronic heart failure.     

Plasma brain natriuretic peptide level as a biochemical marker of morbidity and mortality in patients with asymptomatic or minimally symptomatic left ventricular dysfunction. Comparison with plasma angiotensin II and endothelin-1.

AIMS: To evaluate the level of plasma brain natriuretic peptide as a predictor of morbidity and mortality in patients with asymptomatic or minimally symptomatic left ventricular dysfunction. METHODS: We measured plasma levels of atrial natriuretic peptide, brain natriuretic peptide, norepinephrine, angiotensin II, and endothelin-1 and monitored haemodynamic parameters in 290 consecutive patients with asymptomatic or minimally and newly symptomatic left ventricular dysfunction (functional classes I-II, mean left ventricular ejection fraction=37%). All patients were followed up for a median period of 812 days. The Cox proportional hazards model was used to assess the association of variables with mortality and morbidity. RESULTS: At the end of the follow-up, 24 patients had suffered cardiac death and 25 had been hospitalized for worsening heart failure during the follow-up period. Among 21 variables such as clinical characteristics, treatment, haemodynamics, and neurohumoral factors, high levels of plasma brain natriuretic peptide (P<0.0001), norepinephrine (P=0.042), left ventricular end-diastolic volume index (P=0.0035), and left ventricular end-diastolic pressure (P=0.033) were shown to be independent predictors of mortality and morbidity by stepwise multivariate analysis. Moreover, only a high level of plasma brain natriuretic peptide (P<0.0001) was shown to be an independent predictor of mortality in these patients. CONCLUSIONS: These results indicate that a high plasma brain natriuretic peptide level provides information about mortality and morbidity in patients with asymptomatic or minimally symptomatic left ventricular dysfunction.     

Prognosis in patients with heart failure and preserved left ventricular systolic function.

BACKGROUND: It is recognized that heart failure patients with preserved left ventricular systolic function have better prognosis; nevertheless, there are some studies with conflicting results. Also, there is a paucity of data concerning the prognostic factors in this group of patients. OBJECTIVES: To determine possible variables with prognostic relevance in heart failure patients with preserved left ventricular systolic function (ejection fraction > 40%). METHODS: 157 consecutive ambulatory patients with heart failure were assessed; those patients with ejection fraction > 40% were included in the study (n = 46). All patients were evaluated by clinical interview and physical examination, ECG, echocardiogram (M-mode, 2D and pulsed Doppler of mitral flow), biochemical study and determination of type B natriuretic peptide (BNP). The patients were grouped according to the rhythm presented on ECG: Group I--patients with atrial fibrillation; Group II--patients in sinus rhythm Group II was further subdivided in two groups according to the presence or absence of restrictive left ventricular filling pattern. All patients had a clinical follow-up, with recording of events (death or hospitalization from cardiac cause). The mean follow-up time was 682.2 +/- 55 days. RESULTS: The mean age of the patients was 70.4 +/- 1.2 years; 54.3% were women; mean ejection fraction was 49.6 +/- 1%; mean BNP levels were 202.9 +/- 41.3 pg/ml. Mortality was 19.6% and the combined event death or hospitalization from cardiac cause) occurred in 26.1% of the patients. Among the clinical, demographic, biochemical, echocardiographic and neurohumoral parameters, only BNP levels had prognostic significance in the whole population. In Group II patients, BNP levels, heart rate and restrictive left ventricular filling pattern were identified as having prognostic significance. Kaplan-Meyer curve analysis showed that both BNP and restrictive left ventricular filling pattern seemed to be important prognostic markers. CONCLUSIONS: This preliminary study suggests thar neurohumoral activity (determined by plasma BNP levels) and a restrictive ventricular filling pattern may be important factors in prognostic stratification of heart failure patients with preserved left ventricular systolic function.     

心力衰竭患者N末端A、B及C型利钠肽原与超声心动图和心功能对比分析

目的 评价左心衰竭患者的N末端A型利钠肽原(NT-proANP)、N末端B型利钠肽原(NT-proBNP)和N末端C型利钠肽原(NT-proCNP)分别与临床NYHA心功能分级和超声心动图所测指标的相关性.方法 使用酶联免疫测定的方法测定112例左心衰竭患者(心衰组)和44例正常人(对照组)的血浆NT-proANP、NT-proBNP和NT-proCNP值,并分别与临床NYHA分级、左房内径(LAD)、左室舒张末内径(LVEDD)和左室射血分数(LVEF)进行相关性分析.结果 心衰组的NT-proANP、NT-proBNP、NT-proCNP均显著高于对照组(均为P＜0.05).心衰患者NT-proANP、NT-proBNP和NT-proCNP均两两相关.NT-proANP与NT-proBNP的相关性最强(r=0.790,P=0.000),而NT-proCNP分别与NT-proBNP(r=0.278,P=0.003)和NT-proANP(r=0.236,P=0.012)相关性较弱.单因素分析NT-proANP、NT-proBNP和NT-proCNP与超声心动图指标相关性的结果显示:NT-proANP、NT-proBNP均分别与LAD、LVEDD呈正相关(均为P＜0.05),与LVEF呈负相关(均为P＜0.05).但NT-proCNP未见与LAD、INEDD、INEF有明显相关性.在心衰组,分别引入包括年龄、性别、NYHA分级、超声心动图所测LAD、LVEDD、LVEF共6个因素进行多元逐步回归分析,结果NYHA、LVEF、LAD、年龄与NT-proANP独立相关,NYHA、LVEF、年龄与NT-proBNP独立相关,而NT-proCNP未见与上述因素的相关性.结论 心衰患者血浆NT-proANP、NT-proBNP和NT-proCNP的水平均显著升高,且三者两两相关.不论是单因素还是多元回归分析,NT-proCNP未见与心功能NYHA分级和超声心动图LAD、LVEF、LVEDD的相关性,NT-proCNP不能很好地反映心功能和超声心动图指标.     

心力衰竭患者脑钠素水平与心功能的关系

【目的】研究慢性心力衰竭患者血清脑钠素(BNP)浓度与心功能的关系。方法用酶联免疫吸附法(ELISA)测定62例慢性心力衰竭患者及20名健康对照组血清BNP浓度,采用多普勒超声心动图测定左室射血分数(LVEF)、左室短轴缩短率(FS)、左室舒张末内径(LVEDD),观察BNP水平与LVEF、FS、LVEDD的相关性。结果心衰组血清BNP浓度较对照组明显增高(P<0.01),各心衰组BNP水平差异有统计学意义,且BNP水平随NYHA分级升高而升高。BNP水平与LVEF及FS呈负相关(r=-0.62,r=-0.59,P<0.01),与LVEDD呈正相关(r=0.67,P<0.01)。结论血清CNP浓度可作为反映心功能状态的指标,并与心脏结构有关。     

美托洛尔和福辛普利治疗老年无症状心力衰竭疗效评价

目的：观察美托洛尔和福辛普利对老年无症状性心力衰竭患者血浆脑钠素（BNP）浓度和左室功能的影响。方法：60例未经治疗的无症状性心衰患者随机均分为美托洛尔组和福辛普利组治疗12个月,治疗前、后分别进行心功能评估,测定血浆BNP浓度,并应用超声心动图测量左室射血分数（LVEF）和左室短轴缩短率（FS）。结果：与治疗前比较,治疗后血浆BNP浓度美托洛尔组[（116.3±36.5）ng/L∶（72.1±29.8）ng/L]、福辛普利组[（108.8±27.5）ng/L∶（67.9±31.3）ng/L]均有明显降低（P均〈0.05）;两组LVEF、FS较治疗前亦明显上升（P〈0.05）,两组间上述指标比较均无显著性差异（P〉0.05）。一年的随访期间美托洛尔组和福辛普利组的主要不良心血管事件（MACE）分别为16.7%、6.7%,无显著差异（P〉0.05）。结论：（1）血浆BNP浓度对老年无症状性心衰的诊断及预后评估有重要价值。（2）美托洛尔和福辛普利治疗能降低老年无症状性心衰患者血浆BNP浓度,改善左室功能,延缓无症状性心衰的进展,且两组疗效无明显差异。     

Brain natriuretic peptide (BNP) in coronary insufficiency: relationship with left ventricular filling and exercise tolerance

Brain natriuretic peptide (BNP) is a recently discovered peptide, secreted by the atria and ventricles in response to parietal distension. It was recently proposed as a screening test for left ventricular failure. The authors assayed this peptide at rest in 37 patients with chronic heart failure due to left ventricular systolic dysfunction and another 20 patients with various diseases (respiratory failure, cirrhosis, heart transplantation, "diastolic" heart failure) but normal left ventricular systolic function. A significant increase compared to normal values was observed not only in the group of heart failure patients, but also in patients with all other diseases. BNP was significantly higher in NYHA class IV patients. The relationship between plasma BNP levels and ejection fraction was not significant. On the other hand, a good correlation was observed between BNP and left ventricular filling parameters evaluated by cardiac Doppler: E wave deceleration time (r = -0.53, p = 0.001), E/A ratio: r = 0.57 p = 0.005) or VO2 max (r = -0.55, p < 0.005).     

慢性心力衰竭患者B型脑钠肽水平变化与超声心动图的相关性

目的探讨慢性心力衰竭患者超声心动图指标与外周血B型脑钠肽（BNP）水平变化的关系。方法选择符合诊断标准的慢性心力衰竭患者56例（观察组）,另选同期我院行健康体检的正常人30例（对照组）。观察组根据临床症状按NYHA分级进行分组：Ⅰ级＋Ⅱ级组20例,Ⅲ级组16例,Ⅳ级组20例,共3组。比较分析BNP变化与临床NYHA心功能分级和超声心动图指标的相关性。结果4组研究对象BNP浓度、LVEDD、LAD、LVEF及FS间差异均有统计学意义（P〈0．05）。BNP、LAD、LVEDD分别随心功能分级的升高而升高,呈正相关（P〈0．05）,LVEF和FS随心功能的升高而降低,呈负相关（P〈0．05）。结论慢性心力衰竭患者存在心室结构的重塑。BNP与NYHA心功能分级和超声心动图指标之间存在着明显的相关性。     

Increased interleukin-13 levels in patients with chronic heart failure

A great number of basic and clinical studies have demonstrated that inflammatory cytokines play an important role in development and progress of heart failure. However, there is limited information about allergic cytokine interleukin-13 (IL-13). The inflammatory responses mediated by allergic cytokines can cause significant morbidity and mortality when they become chronic. Therefore, we elucidated the role of IL-13 in the pathophysiology of chronic heart failure. We measured plasma IL-13 levels by enzyme-linked immunosorbent assay in 110 patients with chronic heart failure and 20 control subjects. Plasma IL-13 levels were increased in heart failure patients, compared with the controls, in association with NYHA functional class. In addition, IL-13 levels were correlated positively with plasma levels of brain natriuretic peptide and C-reactive protein, and negatively with left ventricular ejection fraction. Plasma IL-13 levels may be useful for evaluating disease severity in chronic heart failure.     

钠尿肽治疗重症充血性心力衰竭患者的疗效

目的: 观察脑钠尿肽（BNP）治疗重症充血性心力衰竭（CHF）患者的疗效。方法: 纽约心脏学会心功能分级IV级的重症CHF患者44例,在基础抗心衰治疗基础上,应用重组人BNP（rh-BNP）进行治疗,观察患者心率、血压、出入量、中心静脉压、肾功能、血浆BNP水平、左心室舒张末径（LVEDD）和左心室射血分数（LVEF）的变化,观察BNP的疗效。结果: 44例患者中40例患者心衰症状明显改善,总有效率91%。治疗后患者尿量明显增加,心率、中心静脉压、血浆BNP水平均较治疗前明显下降,LVEDD缩小,LVEF较治疗前升高,治疗前后血压和肾功能无明显改变。结论: 外源性rh-BNP的应用可以明显改善患者心衰症状。治疗重症CHF安全,可靠。     

老年慢性心力衰竭患者心功能与神经内分泌系统变化的特点

目的　探讨老年慢性心力衰竭患者心功能状态及神经内分泌系统变化的特点。方法　将入院诊断为慢性心力衰竭急性发作的患者 16 4例分为老年组 (10 0例 )和非老年组 (6 4例 )。根据症状对患者进行心功能分级 (NYHA) ;根据血流动力学指标对患者进行Forrester分级。用放射免疫法测定血浆去甲肾上腺素 (NE)、肾素活性 (PRA)、血管紧张素Ⅱ (AngⅡ )、醛固酮 (ALD)及心房肽 (ANP)和脑钠素 (BNP)浓度。结果　 (1)老年组由缺血性心脏病所致心力衰竭的比例显著高于非老年组 (P <0 .0 5 ) ;(2 )老年组NYHAⅣ级以及ForresterⅣ级的比例较非老年组多 (P <0 .0 1,P <0 .0 5 ) ;(3)老年组心脏指数及左心室射血分数均较非老年组显著降低 (P <0 .0 1,P <0 .0 1) ;(4 )两组患者的神经内分泌因子较正常对照组显著增加 ,老年组除PRA外 ,NE、AngⅡ、ALD、ANP和BNP血浆浓度的增加较非老年组显著为低 (分别为 P <0 .0 5 ,P<0 .0 1,P <0 .0 5 ,P<0 .0 1,P<0 .0 5 )。结论　老年慢性心力衰竭由缺血性心脏病引起者较多 ,急性发作时其临床症状较重 ,心功能低下较为显著 ,但神经内分泌系统的反应性不明显     

慢性心力衰竭患者外周血中血浆肾素活性和利钠肽水平的变化及卡维地洛对其影响

目的　观察慢性心力衰竭 (心衰 )患者外周血中血浆肾素活性 (PRA)、心钠肽 (ANP)及脑钠肽 (N BNP)水平的变化及卡维地洛对其影响。方法　 6 0例慢性心衰患者随机分为常规治疗组 (血管紧张素转换酶抑制 +利尿剂 +地高辛 )和卡维地洛组 (常治疗药物 +卡维地洛 ) ,随访 12w ,采用放射免疫法测定二组治疗前后和 30例健康体检者 (正常对照组 )外周血中PRA、ANP、及N BNP水平。同时使用核素心室显像测定心衰患者左心室射血分数 (LVEF)。结果　心衰患者外周血中PRA、ANP及N BNP水平较正常对照组显著升高 ,其中ANP及N BNP水平在卡维地洛治疗前与LVEF负相关 ,在卡维地洛治疗后与LVEF密切相关 ,但PRA水平与LVEF无关。治疗后卡维地洛组外周血中PRA、ANP及N BNP水平较常规治疗组下降更明显。结论　外周血中ANP及N BNP水平在慢性心衰的病理生理机制中起着重要作用 ,甚至在 β受体阻滞剂治疗后仍可用于指导心衰患者的治疗。β受体阻滞剂能抑制心衰患者神经内分泌的过度激活。     

老年心力衰竭患者血浆脑钠素含量与心功能的关系

目的:探讨老年心力衰竭患者血浆脑纳素(BNP)水平与心力衰竭严重程度,左室功能的关系。方法:采用免疫荧光法测定63例心力衰竭患者和30例对照组血浆BNP浓度,用心脏彩色多普勒超声诊断仪测定并比较各组左室射血分数(LVEF)。结果:心力衰竭患者BNP浓度显著高于对照组(P<0.01);BNP水平随着心功能NY-HA分级程度的加重而显著增高,其与LVEF呈负相关(r=-0.58,P<0.001)。结论:老年心力衰竭患者血浆BNP水平随着心力衰竭严重程度的增加而升高,可反映左室功能状态。     

血浆白细胞介素18对老年慢性心力衰竭诊断及预后判断的作用

目的探讨血浆白细胞介素18(IL-18)对老年慢性心力衰竭(心衰)诊断及预后判断的作用。方法选择老年慢性心衰患者69例(心衰组)和同期健康体检老年人20例(对照组),采用ELISA法测定血浆IL-18、脑钠素(BNP)水平;用心功能分级(NYHA)标准对69例老年心衰患者的心功能进行分级,其中NYHAⅡ级22例,Ⅲ级27例,Ⅳ级20例。超声心动图测定LVEF。结果与对照组比较,心衰组患者血浆IL-18、BNP水平明显升高,LVEF明显降低,差异有统计学意义(P<0.01);与NYHAⅡ级比较,NYHAⅢ级和NYHAⅣ级患者血浆IL-18、BNP水平明显升高(P<0.01),LVEF明显降低(P<0.01);与NYHAⅢ级比较,NYHAⅣ级患者血浆IL-18、BNP水平明显升高(P<0.05,P<0.01)。心衰组患者血浆IL-18与BNP水平和NYHA分级呈正相关(r=0.689,P<0.01;r=0.730,P<0.01),与LVEF呈负相关(r=-0.598,P<0.01)。结论老年慢性心衰患者血浆IL-18水平明显升高,且与BNP、NYHA分级和LVEF具有较好的相关性。联合检测老年慢性心衰患者血浆IL-18、BNP水平有助于心衰诊断及判断预后。     

Effects of human atrial natriuretic peptide on cardiac function and hemodynamics in patients with high plasma BNP levels

Both atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) bind preferentially to the natriuretic peptide A receptor. Therefore, we hypothesized that the positive inotropic and lusitropic effects of ANP might be blunted in patients with moderate congestive heart failure and high BNP levels. Micromanometers and conductance catheters were used to obtain relatively load-insensitive left ventricular pressure-volume analysis in order to compare the myocardial and load-altering actions of ANP in 20 patients with low and high plasma BNP levels. In the low-BNP group (plasma BNP levels <230 pg/ml), ANP infusion significantly decreased end-systolic pressure and end-diastolic pressure and volume, increased end-systolic elastance, and shortened left ventricular relaxation. By contrast, in the high-BNP group (plasma BNP levels >230 pg/ml), the effect of ANP infusion on LV contractility was blunted but its beneficial effects on LV diastolic function and LV-arterial coupling remained. Thus, ANP infusion may improve LV diastolic function even in patients with moderate heart failure and high plasma BNP levels.     

老年慢性心力衰竭患者血浆脑钠肽水平观察

目的 研究血浆脑钠肽(BNP)在老年慢性心力衰竭(CHF)患者的诊断、治疗和预后评估中的临床作用. 方法 选取2010年1月至2011年3月我科住院206例＞60岁老年CHF患者,按照纽约心脏病学会(NYHA)心功能分级分为4组,采用ELISA法测定患者血液BNP的水平,并测定左心室射血分数(LVEF).在抗心力衰竭治疗2周后或出院时复测上述指标,进行统计学分析. 结果 按NYHA心功能分级的各组患者血浆BNP的水平差异具有统计学意义,心功能越严重,年龄越大,BNP值越高,而LVEF差异仅在Ⅰ、Ⅲ、Ⅳ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,复测BNP值下降而LVEF升高,但仅BNP的变化有统计学意义. 结论 BNP值可作为较可靠的老年CHF的早期预测参考指标,也可作为判断心功能不全严重程度和疗效以及预测预后的指标,而且操作简便,易于重复.     

Prognostic impact of big endothelin-1 plasma concentrations compared with invasive hemodynamic evaluation in severe heart failure

Objectives. This study sought to test the hypothesis that big endothelin-1 plasma levels in advanced heart failure are related to survival.Background. In heart failure, production of the potent vasoconstrictor endothelin-1 is increased. Because elevation of immunoreactive endothelin-1 in severe heart failure is primarily related to the precursor “big” endothelin-1, increased big endothelin-1 levels may be associated with a poor prognosis.Methods. Plasma big endothelin-1 concentrations, in addition to 16 clinical, hemodynamic and neurohumoral variables, were obtained from 113 patients (mean age [± SEM] 53 ± 1 years)with left ventricular ejection fraction <20% and were related to 1-year mortality by a stepwise Cox regression multivariate analysis.Results. Plasma big endothelin-1 concentrations were significantly higher in patients with moderate and severe heart failure than in those with mild heart failure (4.5 ± 0.4 and 6.0 ± 0.1 vs. 2.7 ± 0.1 fmol/ml, p = 0.0001, respectively) and lower in 58 one-year survivors than in 29 nonsurvivors (2.6 ± 0.1 vs. 5.9 ± 0.4 fmol/ml, p = 0.0001) and 26 heart transplant recipients. By univariate analysis, big endothelin-1 plasma concentrations (p < 0.0001), functional class, daily furosemide dose, left ventricular ejection fraction, most hemodynamic variables and plasma atrial natriuretic peptide, sodium renin activity and aldosterone levels were all related to mortality, but only functional class provided additional prognostic information when big endothelin-1 plasma levels were entered into the multivariate model.Conclusions. In advanced heart failure, plasma big endothelin-1 is strongly related to survival and appears to predict 1-year mortality better than hemodynamic variables and levels of atrial natriuretic peptide, an established neurohumoral prognostic marker in chronic heart failure.