Plasma B-type natriuretic peptide levels in systolic heart failure: importance of left ventricular diastolic function and right ventricular systolic function

OBJECTIVES: This study was designed to characterize the importance of echocardiographic indexes, including newer indexes of diastolic function, as determinants of plasma B-type natriuretic peptide (BNP) levels in patients with systolic heart failure (SHF). BACKGROUND: Plasma BNP levels have utility for diagnosing and managing heart failure. However, there is significant heterogeneity in BNP levels that is not explained by left ventricular size and function alone. METHODS: In 106 patients with symptomatic SHF (left ventricular ejection fraction [LVEF] <0.35), we measured plasma BNP levels and performed comprehensive echocardiography with assessment of left ventricular diastolic function, including color M-mode (CMM) and tissue Doppler imaging (TDI), and of right ventricular (RV) function. RESULTS: Median plasma BNP levels were elevated and increased with greater severity of diastolic dysfunction. We found significant correlations (p < 0.001 for all) between BNP and indexes of myocardial relaxation (early diastolic velocity: r = -0.26), compliance (deceleration time: r = -0.55), and filling pressure (early transmitral to early annular diastolic velocity ratio: r = 0.51; early transmitral flow to the velocity of early left ventricular flow propagation ratio: r = 0.41). In multivariate analysis, overall diastolic stage, LVEF, RV systolic dysfunction, mitral regurgitation (MR) severity, age and creatinine clearance were independent predictors of BNP levels (model fit r = 0.8, p < 0.001). CONCLUSIONS: Plasma BNP levels are significantly related to newer diastolic indexes measured from TDI and CMM in SHF. Heterogeneity of BNP levels in patients with SHF reflects the severity of diastolic abnormality, RV dysfunction, and MR in addition to LVEF, age, and renal function. These findings may explain the powerful relationship of BNP to symptoms and prognosis in SHF.     

Characterization of left ventricular filling abnormalities and its relation to elevated plasma brain natriuretic peptide level in acute to chronic diastolic heart failure.

BACKGROUND: Although Doppler left ventricular (LV) filling abnormalities have been extensively analyzed in patients with systolic heart failure (SHF), they have not yet been well characterized in patients with acute to chronic diastolic heart failure (DHF) in the light of plasma brain natriuretic peptide (BNP) levels. METHODS AND RESULTS: In 25 patients presenting with acute DHF and 25 with acute SHF, echo Doppler parameters and plasma BNP levels were obtained on admission and in the chronic stage. The mitral E/A ratio was lower in DHF patients than in SHF patients in the acute stage (1.3 +/-0.4 vs 1.8+/-0.9, p<0.05), and in the chronic stage of DHF the ratio decreased with plasma BNP level, but plasma BNP level was still greater than 100 pg/ml in 15 patients (60%). Among patients with DHF the plasma BNP level did not correlate with the mitral E/A ratio or deceleration time (r=0,25, p=NS; r=0,23, p=NS), but did with estimated pulmonary artery systolic pressure (r=0.64, p<0.01). CONCLUSIONS: A restrictive mitral flow velocity pattern is observed in only 25% of patients with DHF, so it is particularly important to recognize pseudonormalization in those with possible DHF. Persistently elevated plasma BNP level is not primarily caused by LV diastolic dysfunction, but by secondary alteration for hemodynamic adjustment (elevated LV end-diastolic pressure) in patients with DHF.     

Myocardial stiffness is an important determinant of the plasma brain natriuretic peptide concentration in patients with both diastolic and systolic heart failure.

AIMS: Plasma brain natriuretic peptide (BNP) concentration increases in proportion to heart failure (HF) severity. Although plasma BNP decreases to a certain level by optimal treatment, there is significant heterogeneity in the baseline value among individuals. The underlying mechanism of the steady-state plasma BNP levels remains still controversial. We investigated the hypothesis that myocardial stiffness (K(m)) is a major determinant of the plasma BNP level. METHODS AND RESULTS: In 19 patients with diastolic HF [DHF; left ventricular ejection fraction (LVEF) > or =4 5%], 18 with systolic HF (SHF; LVEF < 45%), and 12 controls, left ventricular (LV) performance variables and the results of the stress-strain analyses were obtained by the combined simultaneous measurement of echocardiographic and haemodynamic data, and compared with the plasma BNP level. In DHF, a significant correlation was observed between plasma BNP and fractional shortening (P = 0.010), pulmonary capillary wedge pressure (P = 0.030), end-diastolic pressure (P = 0.006), time constant of the LV isovolumic-pressure decline (P = 0.049), end-diastolic stress (P = 0.012), and K(m) (P = 0.004), respectively. In SHF, a significant correlation was observed between plasma BNP and end-diastolic stress (P = 0.036), chamber stiffness (P = 0.048), and K(m) (P = 0.003), respectively. CONCLUSION: In stable conditions, K(m) may be the most important determinant of the plasma BNP production in patients with both DHF and SHF.     

BNP in overweight and obese patients with heart failure: an analysis based on the BNP-LV diastolic wall stress relationship

BackgroundSuppressed plasma B-type natriuretic peptide (BNP) levels have been reported in obese individuals with heart failure (HF). However, the precise mechanism and significance of this relationship in the clinical setting of HF are unknown. Recently, we reported a close association between BNP levels and left ventricular end-diastolic wall stress (EDWS) as the underlying mechanism of BNP secretion; therefore, we investigated the relationship between BMI and plasma BNP levels in HF while adjusting for EDWS.Methods and ResultsIn 245 consecutive patients who presented with HF, we measured plasma BNP levels and performed echocardiography and cardiac catheterization. Meridional EDWS was calculated from echocardiographic and hemodynamic parameters. The body mass index (BMI) for the total population was 22.9 ± 0.2 kg/m²; 21% were lean (BMI <20) and 27% overweight and obese (BMI ≥ 25). The correlation between plasma BNP and EDWS [r = 0.771 (P <.001)] was more robust than any other echocardiographic or hemodynamic parameter as well as any patient's characteristics. By a univariate analysis, BMI was inversely correlated with both BNP levels and EDWS (P <.001 in both). However, a multivariable regression analysis that took into account EDWS demonstrated a significant inverse association between BMI and BNP (P <.001).ConclusionThe present study demonstrates that BMI determines the BNP level in a manner that is independent of the hemodynamic load in patients with HF. Overweight and obesity should be considered to be associated with the interindividual variability of plasma BNP levels in the diagnosis and management of HF patients.     

舒张性心衰和收缩性心衰临床比较(英文)

目的:回顾性分析心衰患者的资料,了解舒张性心衰和收缩性心衰临床特点、费用、疗效等的异同,提高对二者的认识。方法:选择福建医科大学附属协和医院心内科住院的807例心衰患者,根据左室射血分数(LVEF)水平分为两组:LVEF>45%者为舒张性心衰(DHF)组,LVEF≤45%者为收缩性心衰(SHF)组,然后每个组根据NYHA心功能分级分为Ⅱ、Ⅲ、Ⅳ3组。比较两组的临床资料。结果:结构比:DHF和SHF分别占81.3%及18.7%。心功能:相对DHF组,SHF组的NYHAⅢ、Ⅳ级(23.5%,9.6%比47.7%,21.9%),E/A显著增大[(0.74±0.31)比(1.26±0.56)]。临床特点:DHF组女性比例较SHF组显著增大;心脏增大,心律失常比例显著增大,冠心病、肺炎、慢性肾功能不全的比例显著上升,高血压病比例、入院收缩压水平则显著较低,以上P均<0.001;SHF组平均住院时间明显延长[(12.9±8.1)d比(14.5±11.6)d,P<0.05],住院费用[12323(8530～33815)元比19554(9186～49927)元,P<0.05]、住院期间死亡率(0.5%比3.3%,P<0.01)显著较高。结论:舒张性心衰在心衰中占的比例很大,收缩性心衰的心衰更重,心脏损害更重,住院天数更长,住院费用更多、住院期间死亡率更高。     

Alterations in the pattern of collagen deposition may contribute to the deterioration of systolic function in hypertensive patients with heart failure.

OBJECTIVES: We sought to assess the distribution of collagen deposits and collagen degradation in hypertensive patients with either systolic heart failure (SHF) or diastolic heart failure (DHF). BACKGROUND: Increased collagen synthesis and deposition have been described in the myocardium of heart failure (HF) hypertensive patients. METHODS: We studied 39 HF hypertensive patients subdivided into two groups: 16 with SHF and 23 with DHF. Endomyocardial biopsies were performed to quantify mysial (i.e., perimysial plus endomysial) and perivascular and scar-related collagen volume fraction (CVF). Matrix metalloproteinase (MMP)-1 and its tissue inhibitor matrix metalloproteinase (TIMP)-1 were analyzed in cardiac samples by Western blot and immunohistochemistry, and in blood samples by enzyme-linked immunosorbent assay. RESULTS: Mysial CVF was lower in SHF hypertensive patients than in normotensive (p < 0.05) and DHF hypertensive patients (p < 0.01). Perivascular and scar-related CVF was higher (p < 0.05) in the two groups of hypertensive patients than in normotensive subjects, and in SHF hypertensive compared with DHF hypertensive patients. The MMP-1:TIMP-1 ratio was increased (p < 0.05) in tissue and serum samples from the SHF hypertensive group compared with the other two groups of subjects. The MMP-1 expression was increased (p < 0.01) in the interstitium and cardiomyocytes of SHF hypertensive patients compared with DHF hypertensive and normotensive subjects. The serum MMP-1:TIMP-1 ratio was inversely correlated with ejection fraction (r = -0.510, p < 0.001) and directly correlated with left ventricular end-diastolic diameter (r = 0.549, p < 0.001) in all subjects. CONCLUSIONS: These findings show that the pattern of collagen deposits and the balance of the MMP-1/TIMP-1 system are different in the myocardium of SHF and DHF hypertensive patients. It is proposed that excessive degradation of mysial collagen may be related to the compromise of systolic function in HF hypertensive patients.     

Matrix metalloproteinase-1 and -2 levels are differently regulated in acute exacerbation of heart failure in patients with and without left ventricular systolic dysfunction

Matrix metalloproteinases (MMPs) play important roles in progression of chronic heart failure (HF) by regulating cardiac extracellular matrix metabolism. However, there is no report to investigate the difference of circulating MMP-1 and MMP-2 levels between systolic HF (SHF) and diastolic HF (DHF), particularly in light of acute exacerbation of HF. We assessed 110 HF patients who were admitted because of an acute exacerbation. They were divided into two groups: SHF [n = 68, left ventricular ejection fraction (LVEF) <45%] or DHF (n = 42, LVEF ≥45%). Ten patients without HF served as controls. Serum MMP-1 and MMP-2, and plasma brain natriuretic peptide (BNP) levels were examined on admission and at discharge. Serum MMP-1 level was higher on admission in both SHF and DHF than in controls. It was higher in SHF than in DHF and did not change at discharge in both groups. Serum MMP-2 level was equally higher on admission in SHF and DHF than in controls. It decreased in both groups at discharge. Treatment-induced changes in LVEF and BNP level correlated with those in MMP-2 level in SHF but not in DHF. Circulating MMP-1 and MMP-2 levels showed different dynamics between SHF and DHF in acute exacerbation and after treatment. These differences in circulating MMP-1 and MMP-2 levels may be related to the phenotype of HF.     

Diastolic and systolic asynchrony in patients with diastolic heart failure: a common but ignored condition.

OBJECTIVES: The present study aimed to examine whether diastolic and systolic asynchrony exist in diastolic heart failure (DHF) and their prevalence and relationship to systolic heart failure (SHF) patients. BACKGROUND: Few data exist on mechanical asynchrony in DHF. METHODS: Tissue Doppler echocardiography was performed in 373 heart failure patients (281 with SHF and 92 with DHF) and 100 normal subjects. Diastolic and systolic asynchrony was determined by measuring the standard deviation of time to peak myocardial systolic (Ts-SD) and peak early diastolic (Te-SD) velocity using a 6-basal, 6-mid-segmental model, respectively. RESULTS: Both heart failure groups had prolonged Te-SD (DHF vs. SHF vs. controls subjects: 32.2 +/- 18.0 ms vs. 38.0 +/- 25.2 ms vs. 19.5 +/- 7.1 ms) and Ts-SD (31.8 +/- 17.0 ms vs. 36.7 +/- 15.2 ms vs. 17.6 +/- 7.9 ms) compared with the control group (all p < 0.001 vs. control subjects). Based on normal values, the DHF group had comparable diastolic (35.9% vs. 43.1%; chi-square = 1.48, p = NS), but less systolic asynchrony than the SHF group (39.1% vs. 56.9%; chi-square = 8.82, p = 0.003). Normal synchrony, isolated systolic, isolated diastolic, and combined asynchrony were observed in 39.1%, 25.0%, 21.7%, and 14.1% of DHF patients, respectively, and these were 25.6%, 31.3%, 17.4%, and 25.6%, correspondingly, in SHF (chi-square = 10.01, p = 0.019). The correlation between systolic and diastolic asynchrony, and between the myocardial velocities and corresponding mechanical asynchrony appeared weak. A wide QRS duration (>120 ms) was rare in DHF (10.9% vs. 37.7% in SHF) (chi-square = 16.69, p < 0.001). CONCLUSIONS: Diastolic and/or systolic asynchrony was common in 61% of DHF patients despite narrow QRS complex. The presence of asynchrony was not related to myocardial systolic or diastolic function. Systolic and diastolic asynchrony were not tightly coupled, implying distinct mechanisms.     

收缩性和舒张性心力衰竭患者脑利钠肽水平的对比分析

目的：探讨收缩性和舒张性心力衰竭患者血浆脑利钠肽（BNP）水平的差异和收缩性心力衰竭患者脉压与BNP水平的关系。方法：2005年10月至2006年7月在天津医科大学总医院心内科住院患者34例分为两组：收缩性心力衰竭组患者22例，舒张性心力衰竭组患者12例。采取静脉血测定血浆BNP浓度，行超声心动图检查，测量血压，计算脉压。结果：收缩性心力衰竭组的血浆BNP水平、左心室舒张末期内径（LVEDd）比舒张性心力衰竭组的高（p〈0．05～0．001）。收缩性心力衰竭患者BNP水平与脉压、收缩压、左室射血分数（LVEF）呈显著负相关（分别r=-0．58，P〈0．01；r=-0．50，P〈0．05；r=-0．62，P〈0．01），与LVEDd、右心室舒张末期内径（RVEDd）呈正相关（分别r=0．55，P〈0．05；r=0．57，P〈0．05）。结论：收缩性心力衰竭患者血浆BNP水平高于舒张性心力衰竭患者，其血浆BNP水平升高与脉压降低有关。     

Hypoalbuminemia in elderly patients with acute diastolic heart failure

OBJECTIVES: This study evaluated the relative contribution of serum colloid osmotic pressure (COP) lowering and pulmonary artery wedge pressure (PAWP) elevation in the pathogenesis of pulmonary edema in patients with systolic or isolated diastolic heart failure (DHF). BACKGROUND: The role of hypoalbuminemia and the resulting low COP have been shown in some patients with acute systolic heart failure (SHF).Colloid osmotic pressure and PAWP were determined in 100 patients with acute heart failure (HF) (56 with DHF and 44 with SHF; mean age, 78 +/- 12 years), in 35 patients with acute dyspnea from pulmonary origin, and in 15 normal controls. Pulmonary artery wedge pressure was estimated using transthoracic Doppler echocardiography. RESULTS: Colloid osmotic pressure was significantly lower in the DHF group (20.5 +/- 5 mm Hg) than in the SHF group (24.2 +/- 3.7 mm Hg, p < 0.001), pulmonary disease group (25.1 +/- 4.2 mm Hg, p < 0.001), or normal control group (24.7 +/- 3 mm Hg). Low COP resulted from hypoalbuminemia due to age, malnutrition, and sepsis. Pulmonary artery wedge pressure was significantly higher in patients with SHF (26 +/- 6.3 mm Hg) than in the patients with DHF (20.3 +/- 7 mm Hg, p < 0.001) and was significantly higher in the patients with DHF than in the patients with pulmonary disease (13 +/- 4.2 mm Hg, p < 0.001). The COP-PAWP gradient was similar in patients with SHF (-1.6 +/- 7.1 mm Hg) and patients with DHF (0.7 +/- 6 mm Hg). CONCLUSIONS: Frequent hypoalbuminemia resulting in low COP facilitates the onset of pulmonary edema in patients with DHF who usually have lower PAWP than patients with SHF.     

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。     

Systolic and diastolic dyssynchrony in patients with diastolic heart failure and the effect of medical therapy.

OBJECTIVES: The purpose of this study was to determine the prevalence of systolic and diastolic dyssynchrony in diastolic heart failure (DHF) patients and identify the effects of medical therapy. BACKGROUND: The prevalence of systolic and diastolic dyssynchrony in DHF patients is unknown with no data on the effects of medical therapy on dyssynchrony. METHODS: Patients presenting with DHF (n = 60; 61 +/- 9 years old, 35 women) underwent echocardiographic imaging simultaneous with invasive measurements. An age-matched control group of 35 subjects and 60 patients with systolic heart failure (SHF) were included for comparison. Systolic and diastolic dyssynchrony were assessed by tissue Doppler and defined using mean and SD values in the control group. RESULTS: Systolic dyssynchrony was present in 20 patients (33%) with DHF and 24 patients (40%) with SHF and was associated in both groups with significantly worse left ventricular (LV) systolic and diastolic properties (p < 0.05 vs. control group and patients without systolic dyssynchrony). Diastolic dyssynchrony was present in 35 patients (58%) with DHF and 36 patients (60%) with SHF and had significant inverse correlations with mean wedge pressure and time constant of LV relaxation. In DHF patients, medical therapy resulted in significant shortening of diastolic time delay (39 +/- 23 ms to 28 +/- 20 ms; p = 0.02) but no significant change in systolic interval (p = 0.15). Shortening of diastolic time delay correlated well with tau shortening after therapy (r = 0.85; p < 0.001). CONCLUSIONS: Systolic dyssynchrony occurs in 33% of DHF patients, and diastolic dyssynchrony occurs in 58%. Medical therapy results in significant shortening of the diastolic intraventricular time delay which is closely related to improvement in LV relaxation.     

Brain natriuretic peptide. Diagnostic value in heart failure]

BACKGROUND: Nowadays a number of diverse biochemical markers have been identified in patients with heart failure (HF) that could indicate the severity of the patients' illness. Among them, probably the most useful is brain natriuretic peptide (BNP) because it is easily obtained and because of its diagnostic and prognostic information. Our objective was to assess the association between BNP and other different associated variables previously known to be related to the evolution of HF, as well as its utility to distinguish systolic from diastolic HF. PATIENTS AND METHOD: We studied 114 patients admitted consecutively for symptomatic HF for all causes (age: 66 years, male: 60%). In all patients plasma BNP was measured, from the third day of admission, with a specific radioinmunoassay. Echocardiography was performed in 101 patients. RESULTS: BNP plasma levels increased in proportion to functional class (p = 0.01) and the degree of left ventricular dysfunction (p = 0.0001, r = 0.44). There was also an association between BNP and male sex (p = 0.008), higher plasmatic creatinine (p = 0.01, r = 0.25), Iarger ventricular diameters (p = 0.0001) and higher pulmonary systolic pressure (p = 0.001, r = 0.44). In the multivariate analysis, BNP was independently related to the rest of variables with left systolic ventricular function (p = 0.0001). Despite this association, we did not find a satisfactory cut-off value in BNP, with a good sensitivity and specificity value from the total number of patients, of which specifically systolic dysfunction as a cause of HF was detected. CONCLUSIONS: a) BNP increases proportionately to the left ventricular dysfunction and HF severity, and b) BNP is not a useful tool to distinguish systolic from diastolic HF.     

氨基末端脑利钠肽前体和左心室射血分数在老年慢性充血性心力衰竭评估中的作用

目的探讨老年心力衰竭患者血浆氨基末端脑利钠肽前体(NT-proBNP)、左心室射血分数(LVEF)与纽约心功能分级(NYHA)的关系。方法入选2006年1月至2011年10月在我院住院的年龄≥60岁NYHAⅡ～Ⅳ级的慢性心力衰竭患者308例,分为收缩性心力衰竭(SHF)(LVEF<50%)组210例、射血分数正常的心力衰竭(HFNEF)(LVEF>50%)组98例,同期非心力衰竭住院无器质性心脏病患者150例作为对照组,采用电化学发光免疫法检测血浆NT-proBNP浓度,心脏彩色多普勒超声测定左心室结构和LVEF、左心室舒张功能(Ea/Aa)。结果血浆NT-proBNP水平随NYHA分级的增加而升高,二者呈正相关(r=0.862,P<0.01);LVEF与NYHA分级呈负相关(r=-0.614,P<0.05);血浆NT-ProBNP水平与LVEF无明显相关性(r=-0.136,P=0.09)。在SHF组NT-proBNP水平与LVEF呈负相关(r=-0.735,P=0.008),在HFNEF组NT-proBNP水平与Ea/Aa呈正相关(r=0.614,P=0.009)。结论血浆NT-proBNP水平能较好地反映老年慢性心力衰竭患者的心功能状态,LVEF与NT-proBNP结合应用不仅能更好地反映患者心功能状态,同时有助于HFNEF的诊断。     

Autonomic function in elderly patients with chronic heart failure

AIMS: Autonomic function (AF) is attenuated by heart failure (HF). Reports have been based on studies of young patients with systolic heart failure (SHF). However, HF is a disease of older patients who are more likely to have diastolic heart failure (DHF). We investigated whether age alters AF in elderly HF patients and whether the haemodynamic type of HF influences AF. METHOD AND RESULTS: Thirty-six elderly HF (Framingham criteria) patients (11 with SHF, 25 with DHF) and 21 matched healthy subjects underwent simple bedside AF tests. Compared with the reference values for healthy adults, the mean E:I ratios and the median 30:15 ratios standing were all essentially normal. The median 30:15 ratios tilt and the mean Valsalva ratios were all significantly below the reference value (P for all cases <0.050). Comparing three groups, there were no significant differences for mean E:I ratio (P=0.111), 30:15 tilt (P=0.619) and 30:15 standing (P=0.167), whereas there were significant differences for the mean Valsalva ratios (P=0.001). The mean Valsalva ratio of the SHF patients was significantly lower than that for the DHF patients (P<0.001) which in turn was significantly lower than the result of the healthy subjects (P<0.001). CONCLUSION: There is an age-related impairment in AF with further impairment occurring in patients with HF. However, the severity of autonomic dysfunction is less in patients with DHF compared with patients with SHF.     

Comparison of plasma B-type natriuretic peptide levels in single ventricle patients with systemic ventricle heart failure versus isolated cavopulmonary failure

The measurement of plasma B-type natriuretic peptide (BNP) has emerged as a useful biomarker of heart failure in patients with cardiomyopathy. The pathophysiology of heart failure in single ventricle (SV) circulation may be distinct from that of cardiomyopathies. A distinct pattern of BNP elevation in heart failure in the SV population was hypothesized: it is elevated in heart failure secondary to ventricular dysfunction but not in isolated cavopulmonary failure. BNP was measured prospectively in SV patients at catheterization (n = 22) and when assessing for heart failure (n = 11) (7 normal controls). Of 33 SV subjects (median age 62 months), 13 had aortopulmonary connections and 20 had cavopulmonary connections. Median and mean +/- SD BNP levels by shunt type were 184 and 754 +/- 1,086 pg/ml in the patients with aortopulmonary connections, 38 and 169 +/- 251 pg/ml in the patients with cavopulmonary connections, and 10 and 11 +/- 5 pg/ml in normal controls, respectively (p = 0.004). Median systemic ventricular end-diastolic pressure (8mm Hg, R = 0.45), mean pulmonary artery pressure (14.5 mm Hg, R = 0.62), and mean right atrial pressure (6.5 mm Hg, R = 0.54) were correlated with plasma BNP. SV subjects with symptomatic heart failure from dysfunctional systemic ventricles had median and mean +/- SD BNP levels of 378 and 714 +/- 912 pg/ml (n = 18) compared with patients with isolated failed Glenn or Fontan connections (19 and 23 +/- 16 pg/ml [n = 7, p = 0.001]) and those with no heart failure (22 and 22 +/- 12 pg/ml [n = 8, p = 0.001]). Excluding the group with cavopulmonary failure, the severity of heart failure from systemic ventricular dysfunction was associated with plasma BNP. In conclusion, plasma BNP is elevated in SV patients with systemic ventricular or left-sided cardiac failure. BNP is not elevated in patients missing a pulmonary ventricle with isolated cavopulmonary failure.     

Plasma BNP levels are determined by the severity of left ventricular systolic dysfunction but not the types of underlying heart disease

OBJECTIVES: The primary aim of the study was to investigate whether there is a difference in plasma B-type natriuretic peptide (BNP) levels among the left ventricular systolic dysfunction caused by different types of heart disease. METHODS AND RESULTS: Plasma BNP was measured in patients with left ventricular systolic dysfunction as a result of mitral valve regurgitation (n=26), hypertension (n=36), coronary heart disease (n=37) and dilated cardiomyopathy (n=32). The left ventricular end-diastolic diameter and ejection fraction were assessed with echocardiography. The valvular heart disease group had more women and was younger (p < 0.05). There was no significant difference in the New York Heart Association functional class, left ventricular end-diastolic diameter and ejection fraction among the four groups (p < 0.05).The average plasma BNP was also similar among the four groups of patients. In each group, a significant correlation between the levels of BNP and the left ventricular end-diastolic diameter or ejection fraction was identified (p < 0.001). CONCLUSION: Plasma BNP concentrations during left ventricular systolic dysfunction are associated with left ventricular diameter and function, but they are not determined by the causes of the heart failure.     

血浆脑钠素和心钠素对2型糖尿病舒张性心功能不鹊恼锒弦庖邋

采用固相免疫放射分析方法测定47例心脏舒张功能障碍(DHF)的2型糖尿病(DM)患者血浆脑钠素(BNP)和心钠素(ANP)浓度,并与DM心功能正常组(24例)及正常对照组(12名)进行对比分析。结果显示血浆BNP、ANP水平随着DHF程度加重而逐渐升高,而且E/A比值与BNP(r=-0.669,P<0.01)和ANP(r=-0.579,P<0.01)均呈显著负相关,提示血浆ANP、BNP是诊断2型DM心脏舒张功能不全的良好生化指标。     

舒张性心力衰竭患者血浆Apelin-12水平变化

目的:探讨舒张性心力衰竭(心衰)患者血浆Apelin-12水平的变化及临床意义。方法:选择2010-01-2010-06期间在我院心内科住院的慢性心衰患者60例,舒张性心衰(A组)20例,收缩性心衰(B组)40例,后者再分为3个亚组,心功能Ⅱ级组9例,心功能Ⅲ级组20例,心功能Ⅳ级组11例。健康体检者20例为对照组。酶联免疫吸附法(ELISA)测定血浆Apelin-12水平。结果:A组和B组血浆Apelin-12水平均明显低于对照组[(1.55±0.18)ng/L,(0.91±0.15)ng/L∶(3.55±0.26)ng/L,均P<0.05],其中,A组高于B组,P<0.05。B组不同的心功能分级Apelin-12水平差异无统计学意义,P=0.126。结论:舒张性心衰患者和收缩性心衰患者,血浆Apelin-12水平均降低,与心功能分级无关。     

脑钠肽和N末端脑钠肽前体在老年舒张性心力衰竭患者中的比较

目的对老年舒张性心力衰竭(DHF)患者血浆脑钠肽(BNP)和N末端脑钠肽前体浓度进行比较,探讨其在老年DHF中的诊断价值。方法对诊断为DHF的老年患者129例(DHF组)及老年健康体检者77例(对照组)行心脏超声检查,应用酶联免疫法测定其血浆BNP浓度,采用电化学发光法双抗体夹心免疫法测定血浆N末端脑钠肽前体浓度,比较两组血浆BNP和N末端脑钠肽前体浓度及其与心脏舒张功能障碍分级的关系,并作受试者ROC曲线分析。结果DHF组血浆BNP和N末端脑钠肽前体水平均较对照组显著升高(P<0.01);且与舒张功能障碍程度相对应(P<0.01);血浆N末端脑钠肽前体水平高于BNP,并显著相关(r=0.812,P<0.01);ROC曲线下面积(AUC)为0.711(95%CI:0.630~0.792),120 ng/L作为界值的灵敏性为81.0%,特异性为63.3%;N末端脑钠肽前体AUC为0.765(95%CI:0.691~0.839),200 ng/L作为界值的灵敏性为82.3%,特异性为73.3%。结论血浆BNP和N末端脑钠肽前体均对老年DHF有一定的诊断价值;N末端脑钠肽前体是一个较BNP更为敏感的诊断DHF的生化指标。