左心房容积及血浆脑钠肽评价左室射血分数正常心力衰竭的价值

目的评价左心房容积及血浆脑钠肽在左室射血分数正常心力衰竭诊断中的价值。方法前瞻性研究心力衰竭患者54例,其中左室射血分数正常心力衰竭(LVEF>50%)患者29例和收缩性心力衰竭。结果 (1)收缩性心力衰竭及左室射血分数正常心力衰竭两组患者的血浆BNP浓度均显著高于对照组(P<0.01),收缩性心力衰竭组血浆BNP浓度明显高于左室射血分数正常心力衰竭组(P<0.01)。(2)以血浆BNP125pg/ml为临界值,诊断左室射血分数正常心力衰竭的敏感性为:72.4%,特异性为:94.1%,阳性预测值为:91.3%,阴性预测值为:69.2%。(3)左室射血分数正常心力衰竭患者中,以血浆BNP为反映左室充盈压的间接指标,在超声心动图各指标中,相关性分析表明左心房容积指数与血浆LgBNP存在显著的正相关(r=0.773,P<0.0001)。(4)左心室射血分数正常心力衰竭组患者血浆BNP水平随NYHA心功能分级的级数增高而升高,且在各级NYHA心功能分级之间均有显著差异(P<0.01)。血浆BNP水平随左室舒张功能的恶化而升高,且在舒张功能各阶段之间均有显著差异。(5)左心室射血分数正常心力衰竭患者左心房容积指数随NYHA心功能分级的级数增高而升高,且在各级NYHA心功能分级之间均有显著差异(P<0.01)。左心房容积指数随左室舒张功能的恶化而升高,且在舒张功能各阶段之间均有显著差异。结论 (1)左心室射血分数正常心力衰竭患者血浆BNP水平与左心房容积指数明显升高,其升高的幅度与纽约心功能分级及舒张功能不全严重程度一致。(2)在排除收缩功能不全后,血浆BNP水平升高可作为左室射血分数正常心力衰竭诊断的指标之一。(3)在收缩功能正常的情况下,二尖瓣血流频谱及肺静脉血流频谱不能准确评估左心室舒张功能,而左房容积增大可用来评估舒张功能不全及其严重程度。     

急性心肌梗死患者行经皮冠状动脉介入术对血清B型钠利尿肽及心室重塑的影响

目的研究采用经皮冠状动脉介入(PCI)术对急性心肌梗死(AMI)患者血清B型钠利尿肽(BNP)及心室重塑的影响。方法将60例AMI患者按有无行PCI术分为PCI组和非PCI组,检测不同时期血清BNP水平以及采用PhillipsIE33型多普勒超声仪测定患者1周左右的左心室内径、左心室收缩末期容积(ESV)、左心室舒张末期容积(EDV)、左室射血分数(LVEF)。结果两组患者EDV、ESV和LVEF比较,差异均有统计学意义(P<0.05)。两组患者在24h、48h、72h时点血清BNP水平比较,差异均无统计学意义(P>0.05);7d时两组比较,差异有统计学意义(P<0.05)。结论采用PCI术对AMI患者进行早期再灌注可明显降低患者第7天的BNP水平,进而能改善AMI患者的左室功能及减轻左室重塑。     

替米沙坦联合螺内酯对慢性心力衰竭患者血浆脑钠肽及左心室功能的影响

目的探讨替米沙坦联合螺内酯对慢性心力衰竭(CHF)患者血浆脑钠肽(BNP)及左心室功能的影响。方法心力衰竭患者82例,随机分为2组,常规治疗组(对照组)40例,联合治疗组(治疗组)42例,对照组接受常规抗心力衰竭治疗,治疗组在对照组基础上给予替米沙坦及螺内酯联合治疗。3月后,观察血浆BNP水平变化及超声心动图各项指标,并进行比较。结果治疗3月后,2组间血浆BNP浓度、左室舒张末期容积(LV-EDV)、左室收缩末期容积(LVESV)和左室射血分数(LVEF)比较差异有统计学意义(P均<0.05)。结论替米沙坦联合螺内酯治疗CHF能有效地改善患者心功能,预防左心室重构,明显改善预后。     

飞利浦工作站和西门子工作站测定门控心肌灌注显像心功能参数的比较研究

目的:不同工作站作为图像重建与定量分析的平台,可能会影响门控心肌灌注显像的心功能参数,本研究就此比较飞利浦工作站与西门子工作站使用QGS软件测定的门控心肌灌注显像心功能参数.方法:连续选取51例行门控心肌灌注显像的患者,分成小心脏组(收缩末期容积<30 ml)与非小心脏组(收缩末期容积≥30 ml).分别通过飞利浦工作站与西门子工作站进行图像重建,重建条件相同,利用QGS软件对重建图像进行定量分析,计算左心室射血分数、舒张末期容积与收缩末期容积.结果:飞利浦工作站与西门子工作站之间左心室射血分数、舒张末期容积以及收缩末期容积配对t检验,差异均有统计学意义(P<0.05);Bland-Altman分析95%一致性界限分别为-0.036-0.026,-3.10-8.36,-2.53-5.90.在两个工作站之间,小心脏组,左心室射血分数、舒张末期容积以及收缩末期容积,差异均有统计学意义(P<0.05);非小心脏组,舒张末期容积以及收缩末期容积,差异均有统计学意义(P<0.05);左心室射血分数,差异无统计学意义(P=0.61).结论:飞利浦工作站与西门子工作站测定的门控心肌灌注显像心功能参数存在差异.从临床角度,两种工作站一致性尚可,可以替代使用,但同一患者的随访复查及心肌顿抑的评价仍应在同种工作站进行.     

脑利钠肽对急诊冠状动脉介入治疗急性心肌梗死左室结构和功能的评估价值

目的:观察急性心肌梗死(AMI)患者接受急诊经皮冠状动脉介入(PCI)治疗前后的脑利钠肽(BNP)水平变化及其与左室功能,心室重构的关系,探讨BNP在急诊PCI治疗AMI患者预后评估中的作用.方法:入选2008-06-2009-02,发病后12 h内接受急诊PCI治疗的ST段抬高型急性心肌梗死(STEMI)患者120例,入院即时及出院时采用酶联免疫法测定患者血浆BNP水平,出院前行超声心动图检测左室射血分数,并根据PCI治疗后7 d的BNP水平将患者分为3组:A组<100 ng/L,B组为100～400 ng/L,C组>400 ng/L.所有患者术后6个月进行超声心动图检查,根据左室射血分数、左室舒张末期容积、左室收缩末期容积变化评估左室功能及心室重构.结果:BNP水平与AMI病变范围呈正相关,与左室射血分数呈负相关;PCI治疗后不同心肌梗死部位BNP水平较治疗前均明显下降;3组患者PCI治疗后6个月的超声心动图比较,患者左室射血分数、左室舒张末期容积、左室收缩末期容积B组、C组与A组相比差异有统计学意义(P<0.05),C组与B组比较差异也有统计学意义(P<0.05).结论:血浆BNP水平可反映AMI的严重程度;BNP增加的程度与梗死的范围呈正相关;AMI患者急诊PCI后BNP水平有显著下降趋势;BNP水平可能可以作为患者左室功能及心室重构的预测因子.     

卡维地洛对慢性心力衰竭患者心功能及血浆脑钠肽、N末端脑钠肽前体水平的影响

目的探讨卡维地洛对慢性心力衰竭(CHF)患者心功能及血浆脑钠肽(BNP)、N末端脑钠肽前体(NT-pro BNP)水平的影响。方法选取无锡市人民医院2012年6月—2014年6月收治的老年CHF患者120例,随机分为观察组和对照组,各60例。两组患者均给予常规治疗,观察组患者在常规治疗基础上给予卡维地洛治疗,两组患者均治疗6个月。比较两组患者治疗前后血压〔收缩压(SBP)和舒张压(DBP)〕、心功能指标〔左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)和左心室舒张末期内径(LVEDD)〕及血浆BNP、NT-pro BNP水平。结果治疗前两组患者SBP、DBP、LVEF、LVEDD和LVESD比较,差异无统计学意义(P>0.05);治疗后观察组患者SBP和DBP低于对照组,LVEF高于对照组,LVEDD和LVESD小于对照组(P<0.05)。治疗前两组患者血浆BNP和NT-pro BNP水平比较,差异无统计学意义(P>0.05);治疗后观察组患者血浆BNP和NT-pro BNP水平低于对照组(P<0.05)。结论卡维地洛能有效改善CHF患者心功能,降低血浆BNP和NT-pro BNP水平,进而改善患者预后。     

缬沙坦对急性冠脉综合征患者脑钠肽及高敏C反应蛋白的影响

目的:观察急性冠脉综合征患者缬沙坦治疗前后血浆脑钠肽(BNP)及高敏C反应蛋白(hsCRP)的变化,探讨缬沙坦抑制心室重构的作用机制.方法:急性冠脉综合征患者66例(急性心肌梗死43例,不稳定性心绞痛23例),随机分为治疗组(n=32)和对照组(n=34),分别检测两组治疗前、治疗1个月、治疗6个月,血浆BNP、hsCRP水平及心室结构功能的变化.结果:治疗后治疗组、对照组的急性心肌梗死患者、不稳定性心绞痛患者血浆BNP和hsCRP水平均呈下降趋势,治疗组治疗1个月下降明显、治疗6个月降低速度减慢,治疗组治疗1个月、6个月与同时间段对照组相比下降,对照组、治疗组与同组前一时间段相比亦下降,差异均有统计学意义(P<0.05～0.01).治疗1个月,两组患者左心室射血分数、左心室收缩末期内径及左心室舒张末期内径均无明显变化(P>0.05);治疗6个月,治疗组左心室射血分数较对照组明显升高(P<0.01),左心室收缩末期内径及心室舒张末期内径较对照组明显减小(P均<0.01),差异均有统计学意义.结论:血管紧张素Ⅱ受体拮抗剂缬沙坦能够抑制急性冠脉综合征患者血浆BNP及hsCRP的分泌,降低炎性反应,抑制心室重构.改善心功能.     

AMI患者血浆脑钠肽水平测定及其与左室重构的关系

测定对68例急性心肌梗死(AM I)患者发病后48 h内(早期)血浆脑钠肽(BNP)水平;于发病后28~30 d行超声心动图检查,测量左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)和左心室射血分数(LVEF)。对血浆BNP水平与LVESV、LVEDV、LVEF进行相关性分析。结果LVEF≤40%者血浆BNP水平显著高于LVEF>40%者,P<0.05;血浆BNP水平与LVESV、LVEDV呈正相关,与LVEF呈负相关。认为AM I早期血浆BNP水平升高与其28~30 d左室重构程度密切相关,应积极进行干预治疗。     

慢性心力衰竭患者血浆脑钠肽水平变化及其对预后的影响研究

目的探讨慢性心力衰竭患者血浆脑钠肽水平变化及其对预后的影响。方法选取海南省农垦那大医院2010年2月—2011年2月收治的慢性心力衰竭患者120例,参照纽约心脏病协会(NYHA)心功能分级标准分为心功能Ⅱ级组、心功能Ⅲ级组和心功能Ⅳ级组,每组40例。观察各组患者血浆脑钠肽水平、左心室舒张末期内径、左心室射血分数;患者出院后随访1~3年,观察血浆脑钠肽水平升高者与正常者死亡情况、年平均住院次数及年平均住院时间。结果心功能Ⅳ级组患者血浆脑钠肽水平、左心室舒张末期内径高于心功能Ⅲ级组和心功能Ⅱ级组,左心室射血分数低于心功能Ⅲ级组和心功能Ⅱ级组,心功能Ⅲ级组患者血浆脑钠肽水平、左心室舒张末期内径高于心功能Ⅱ级组,左心室射血分数低于心功能Ⅱ级组(P0.05)。心功能Ⅲ级组、心功能Ⅳ级组患者血浆脑钠肽水平升高率高于心功能Ⅱ级组(P0.05),而心功能Ⅲ级组与心功能Ⅳ级组患者血浆脑钠肽水平升高率比较,差异无统计学意义(P0.05)。血浆脑钠肽水平升高组患者病死率高于血浆脑钠肽水平正常组,年平均住院次数多于血浆脑钠肽水平正常组,年平均住院时间长于血浆脑钠肽水平正常组(P0.05)。结论血浆脑钠肽水平可反映慢性心力衰竭患者心功能,对判断患者病情严重程度及预测患者预后有一定的参考价值。     

静脉应用重组人B-型利钠肽对急性心肌梗死冠状动脉介入术后心室重塑和收缩同步性的影响

目的:研究静脉应用重组人B-型利钠肽(rhBNP)对急性心肌梗死冠状动脉(冠脉)介入术后患者心室重塑和收缩同步性的影响.方法:选择48例12 小时内发病的急性前壁心肌梗死冠脉介入术后患者,随机分为rhBNP组25例和常规治疗组23例,分别于治疗后1周、4周和24周采用二维超声心动图测定舒张末期容积指数、收缩末期容积指数、左心室射血分数、左心室质量指数,梗死区的局部室壁运动指数.于治疗后1周、24周时行平衡法核素心室造影,了解心室收缩同步性参数.结果:①治疗后1周时,rhBNP组左心室收缩末期容积指数较常规治疗组降低、左心室射血分数较常规治疗组升高 (P<0.05).治疗后4周、24周时,rhBNP组左心室舒张末期容积指数、左心室收缩末期容积指数、左心室射血分数较常规治疗组差异均有统计学意义.治疗后24周时,rhBNP组的左心室质量指数,梗死区的局部室壁运动指数较常规治疗组明显下降,差异均有统计学意义 (P<0.05).②治疗后1周时心室相角程、半高宽、峰相位标准差在两组患者间差异无统计学意义 (P>0.05),治疗后24周时rhBNP组上述3项指标较常规治疗组差异有统计学意义(P<0.05).结论:冠脉介入术后在常规治疗的基础上应用rhBNP可进一步阻抑急性前壁心肌梗死后心室重塑,提高心室收缩同步性,改善左心功能.     

应用主动脉内球囊反搏对急性心肌梗死急诊经皮冠状动脉介入术后慢血流现象患者血浆脑钠肽水平及左室功能的影响

目的探讨应用主动脉内球囊反搏(IABP)对急性ST段抬高心肌梗死(STEMI)冠状动脉介入治疗术后慢血流(SCF)患者血浆脑钠肽(BNP)水平及左心室功能的影响。方法分析2008年1月—2010年12月因STEMI行PCI术后SCF现象患者28例资料,采用单双日分组方法将其中14例运用IABP治疗分为治疗组,其余14例为对照组,观察术后1h心电图梗死相关导联ST回落及术前、术后24h、术后1周BNP水平差异;治疗10d后应用彩色超声心动图测量患者左心房内径、左心室内径、左心室射血分数(LVEF);并随访3个月、6个月左心房内径、左心室内径、LVEF变化情况。结果术后1h心电图ST回落50%者对照组组占28.1%,治疗组占61%;术前两组BNP水平无明显差异,术后24h对照组为(365.1±121.6)ng/L,治疗组为(278.4±92.7)ng/L;术后1周对照组为(295.7±65.8)ng/L,治疗组为(203.8±64.7)ng/L,P<0.05。超声心动图测量两组患者恢复期LVEF值差别有明显统计学意义。结论急性STEMI患者直接PCI术后SCF现象患者应用IABP明显影响BNP水平,提高恢复期LVEF值,对心功能可能有一定的改善作用。     

急诊经皮冠状动脉介入治疗对急性心肌梗死血浆脑钠肽水平的影响

目的观察急诊经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMI)患者血浆脑钠肽(BNP)水平的影响。方法AMI患者76例,分为急诊PCI组42例,未再灌注治疗组34例。同时检测入院即刻、入院后1、7、28d血浆BNP浓度进行比较。结果入院即刻两组患者BNP浓度差异无统计学意义(P>0.05),入院后1d、7d和28d急诊PCI组BNP浓度显著低于对照组(P<0.01)。结论急诊PCI治疗能降低AMI患者血浆BNP水平。     

Plasma levels of brain natriuretic peptide in patients with cirrhosis.

Plasma levels of brain natriuretic peptide, a recently identified cardiac hormone with natriuretic activity, were measured in 11 healthy subjects, 13 cirrhotic patients without ascites, 18 nonazotemic cirrhotic patients with ascites and 6 patients with cirrhosis, ascites and functional kidney failure. Plasma levels of brain natriuretic peptide were similar in healthy subjects and cirrhotic patients without ascites (5.56 +/- 0.65 and 7.66 +/- 0.68 fmol/ml, respectively). In contrast, cirrhotic patients with ascites, with and without functional kidney failure, had significantly higher plasma concentrations of brain natriuretic peptide (19.56 +/- 1.37 and 16.00 +/- 1.91 fmol/ml, respectively) than did healthy subjects and patients without ascites (p less than 0.01); no significant difference was found between the two groups of cirrhotic patients with ascites with respect to this parameter. In the whole group of cirrhotic patients included in the study, brain natriuretic peptide level was directly correlated with the degree of impairment of liver and kidney function, plasma renin activity and plasma levels of aldosterone and atrial natriuretic peptide. The results of this study indicate that brain natriuretic peptide is increased in cirrhotic patients with ascites and suggest that sodium retention in cirrhosis is not due to deficiency of this novel cardiac hormone.     

Effects of lesion complexity on baseline and postprocedural B-type natriuretic peptide levels in patients undergoing percutaneous coronary interventions

The time-related alteration of plasma B-type natriuretic peptide levels after percutaneous coronary interventions has been investigated chiefly in patients with acute coronary syndromes; very few data are available in patients with stable coronary artery disease. Therefore, we aimed to evaluate the alterations of plasma B-type natriuretic peptide levels, and the effects of lesion complexity on these levels, after elective percutaneous coronary interventions in stable coronary artery disease patients. We enrolled 103 of these patients and used modified American College of Cardiology/American Heart Association lesion morphology criteria to qualitatively evaluate the angiograms: type A and B1 lesions were categorized as simple, and type B2 and C lesions were designated as complex. Plasma B-type natriuretic peptide levels were determined before intervention and 1 and 24 hours afterwards. Median baseline B-type natriuretic peptide levels were significantly higher in patients who had complex lesions (n=53) (108 pg/mL) compared with those who had simple lesions (n=50) (33 pg/mL) (P <0.001), and this difference was maintained 1 and 24 hours after intervention (P = 0.003 and P = 0.001, respectively). However, for both lesion types, percutaneous coronary intervention procedures did not significantly alter plasma B-type natriuretic peptide levels (all P >0.05). On binary logistic regression analysis, age and lesion complexity were found to be independently associated with B-type natriuretic peptide levels. We conclude that, in stable coronary artery disease patients, elective percutaneous coronary intervention does not cause any significant alteration in plasma B-type natriuretic peptide levels. However, elevated levels are significantly associated with more complex lesions and with advanced age.     

冠心病患者PCI术后6个月血浆NT-proBNP水平的变化及临床意义

目的: 观察冠心病患者行经皮冠状动脉介入治疗（PCI）前和6个月以后血浆中氨基末端脑钠尿肽前体（N-terminal pro-brain natriuretic peptide, NT-proBNP）水平的变化,探讨其临床意义和近期预后价值。方法: 将经冠状动脉造影（CAG）证实的71例冠心病患者,分为PCI组（51例）和对照组（20例）,用电化学发光免疫分析法动态观察其血浆NT-proBNP浓度,分别比较PCI组术前、术后即刻、术后6 h、术后24 h和术后6个月血浆NT-proBNP水平的变化情况,以及随访期间PCI组与对照组患者血浆NT-proBNP浓度的变化。经超声心动图检测两组患者住院期间与术后6个月左心室舒张末期内径（LVEDD）和收缩末期内径（LVESD）,室间隔（IVSW）与左室后壁厚度（LVPW）,左室射血分数（LVEF）,左室短轴缩短率（FS）及E/A比值以评价心功能。结果: PCI组术后6个月血浆Log NT-proBNP浓度［(2.0±0.5)ng/L］显著低于术前［(2.4±0.5)ng/L］水平（P<0.05）。对照组患者6个月后血浆Log NT-proBNP浓度［(2.5±0.6)ng/L］明显高于PCI组［(2.0±0.5)ng/L］（P<0.05）。比较超声心动图各项指标,PCI组患者术后6个月LVEF［(62±10)%］较术前［(64±10)%］有所下降（P<0.05）。结论: 冠心病患者行PCI术后6个月血浆NT-proBNP水平显著降低,提示血运重建与药物治疗联合可能优于单纯药物治疗,并且NT-proBNP对冠心病患者可能具有近期预后价值,可以指导临床医生早期干预,尽可能降低冠心病发病率和死亡率。     

血浆脑钠尿肽水平与冠状动脉支架植入术后再狭窄有关

目的:探讨冠心病患者血浆脑钠尿肽(BNP)水平与冠状动脉支架内再狭窄的关系。方法:选择317例接受冠状动脉支架植入术(PCI)以及术后1年内再次接受冠状动脉造影(CAG)检查的患者,分为再狭窄和无再狭窄组,分别在PCI术前、出院前和复查CAG前测定血浆BNP水平,两组患者分别比较相应的BNP水平。结果:再狭窄组PCI术前、出院前及复查CAG前的BNP水平与无再狭窄组分别进行比较,差异有统计学意义(P0.05),多因素logistic回归分析结果,血浆BNP水平是预测再狭窄的独立危险因子(均P0.01)。结论:血浆BNP水平与PCI术后再狭窄密切相关,有可能作为再狭窄的有用预测指标。     

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。     

The influence of percutaneous closure of patent ductus arteriosus on left ventricular size and function: a prospective study using two- and three-dimensional echocardiography and measurements of serum natriuretic peptides.

OBJECTIVES: We aimed to evaluate the effect of percutaneous closure of patent ductus arteriosus (PDA) on left ventricular (LV) hemodynamics. BACKGROUND: Today, most PDAs are closed percutaneously. Little is known, however, about hemodynamic changes after the procedure. METHODS: Of 37 children (ages 0.6 to 10.6 years) taken to the catheterization laboratory for percutaneous PDA closure, the PDA was closed in 33. Left ventricular diastolic and systolic dimensions, volumes, and function were examined by two-dimensional (2D) and three-dimensional (3D) echocardiography and serum concentrations of natriuretic peptides measured before PDA closure, on the following day, and 6 months thereafter. Control subjects comprised 36 healthy children of comparable ages. RESULTS: At baseline, LV diastolic diameter measured >+2 SD in 5 of 33 patients. In 3D echocardiography, a median LV diastolic volume measured 54.0 ml/m2 in the control subjects and 58.4 ml/m2 (p < 0.05) in the PDA group before closure and 57.2 ml/m2 (p = NS) 6 months after closure. A median N-terminal brain natriuretic peptide (pro-BNP) concentration measured 72 ng/l in the control group and 141 ng/l in the PDA group before closure (p = 0.001) and 78.5 ng/l (p = NS) 6 months after closure. Patients differed from control subjects in indices of LV systolic and diastolic function at baseline. By the end of follow-up, all these differences had disappeared. Even in the subgroup of patients with normal-sized LV at baseline, the LV diastolic volume decreased significantly during follow-up. CONCLUSIONS: Changes in LV volume and function caused by PDA disappear by 6 months after percutaneous closure. Even the children with normal-sized LV benefit from the procedure.     

氯沙坦对高血压左室肥厚患者血浆脑钠肽的影响

目的：研究氯沙坦干预对高血压伴左室肥厚患者脑钠肽（BNP）的影响及意义。方法：选择100例左室射血分数正常范围的高血压患者,其中58例伴左室肥厚,42例不伴左室肥厚,另选50例健康者作为健康对照组,比较三组间血浆BNP水平。左室肥厚组给予氯沙坦治疗6个月,比较治疗前后BNP、左室质量指数（LVMI）的变化。结果：①高血压伴左室肥厚患者BNP浓度显著高于不伴左室肥厚组及健康对照组[（62．21±9．70）pg／ml比（39．35±10．57）pg／ml比（13．89±5．34）pg／ml,P〈0．01];②BNP的浓度与LVMI呈正相关（r=0．44,P〈0．05）;③与治疗前比较,氯沙坦治疗高血压伴左室肥厚6个月后,血浆BNP[（62．21±9．70）pg／ml比（38．78±7．94）pg／m1]、LVMI[（128．71±12．64）g／m。比（107．36±11．32）g／m。]均显著降低（P〈o．01）。结论：氯沙坦可明显降低高血压伴左室肥厚患者脑钠肽水平,逆转左室肥厚。     

The role of brain natriuretic peptide in the prediction of cardiac performance in coronary artery bypass grafting

The relationship between brain natriuretic peptide and cardiopulmonary bypass has not been examined sufficiently. In this study, we prospectively examined brain natriuretic peptide levels in the plasma of 26 patients undergoing coronary artery bypass grafting. Brain natriuretic peptide measurements were carried out at 4 times: preoperatively, 3 hours after institution of cross-clamping, 24 hours after institution of cross-clamping, and on the 5th postoperative day. In addition, we measured individual variables and compared them to brain natriuretic peptide levels. Mean preoperative brain natriuretic peptide levels were significantly higher in patients with histories of myocardial infarction (P = 0.0047) and heart failure (ejection fraction < or = 0.40) (P = 0.0001). There was a significant correlation between preoperative brain natriuretic peptide levels and cross-clamp times (P = 0.028), and an inverse correlation between those levels and preoperative cardiac indices (P = 0.001). The preoperative brain natriuretic peptide level also correlated inversely with left ventricular ejection fraction before (P = 0.001) and 5 days after (P = 0.01) operation. When the Clinical Severity Scoring System was applied, preoperative brain natriuretic peptide plasma concentrations in 19 patients with risk scores of 0-2 were significantly lower than in the 7 patients whose risk scores were 3-6 (P = 0.006). There was also a significant relationship between preoperative brain natriuretic peptide plasma concentrations and the postoperative requirement for inotropic agents (P = 0.027). This study suggests that plasma brain natriuretic peptide concentration could be one of the predictors of risk in patients undergoing coronary artery bypass grafting.