Brain Natriuretic Peptide and Biomarkers of Myocardial Ischemia Increase after Defibrillation Threshold Testing
Brain Natriuretic Peptide and Biomarkers of Myocardial Ischemia Increase after Defibrillation Threshold Testing
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DOI：
10.1111/j.1540-8159.2011.03275.x
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发表时间：
2012-03-01
影响因子：
1.8
通讯作者：
Daniels, Steven
中科院分区：
文献类型：
--
作者：
Francis, Charles K.;Kuo, Yen-Hong;Daniels, Steven
背景：在植入心脏转复除颤器时，使用诱导性室颤，然后进行电击试验(除颤阈值测试[DFT])，以确认有效的装置功能。DFT对心功能的影响尚不确定。脑钠素(BNP)是心功能不全和血流动力学应激的标志物。方法：对31例患者(平均年龄71.4岁，女性12例)在DFT前(T1)、DFT后2-4小时(T2)和8-12小时(T3)测定BNP、肌酸激酶同工酶(CK-MB)和肌钙蛋白I(CTnI)。比较接受一次电击(A组)和两次电击(B组)的患者的生物标志物水平。结果：DFT后，所有生物标志物的水平均高于基线水平，但未达到心肌梗死的诊断水平。从T1到T2，CK-MB和cTnI升高的比例最高(CK-MB 90%，cTnI 84%)。从T1到T3，BNP和cTnI升高最为普遍(BNP 83%，cTnI 90%)。脑钠素水平从T1到T3(P=0.0003)、CK-MB水平从T1到T2(P<；0.0001)、cTnI水平从T1到T2(P<；0.0001)和从T1到T3(P<；0.0001)显著增加。从T1到T3，CK-MB水平无明显升高(P=0.51)。结论：DFT后BNP水平逐渐升高，并伴有早期CK-MB升高和cTnI持续升高。这些数据表明DFT与血流动力学应激和左心功能不全有关，BNP的增加证明了这一点。(Pace 2012；35：314-319)
Background: During implantable cardioverter defibrillator insertion, induced ventricular fibrillation followed by test shocks (defibrillation threshold testing [DFT]) is utilized to confirm effective device function. The effect of DFT on ventricular function is uncertain. Brain natriuretic peptide (BNP) is a marker of ventricular dysfunction and hemodynamic stress. We hypothesized that DFT causes increased BNP levels.Methods: BNP, creatine kinase, creatine kinase-MB (CK-MB), and troponin I (cTnI) were measured in 31 patients (mean age 71.4 years; 12 women) at preinsertion (T1), at 2-4 hours (T2), and at 8-12 hours (T3) after DFT. Biomarker levels were compared in patients receiving one shock (Group A) or two shocks (Group B).Results: After DFT all biomarkers increased above baseline levels but did not reach levels diagnostic for myocardial infarction. From T1 to T2, elevations in CK-MB and cTnI occurred in the highest proportion of patients (CK-MB 90% and cTnI 84%). From T1 to T3, elevation in BNP and cTnI were most prevalent (BNP 83% and cTnI 90%). Significant increases were measured in BNP levels from T1 to T3 (P = 0.0003), CK-MB levels from T1 to T2 (P < 0.0001), and cTnI levels from T1 to T2 (P < 0.0001) and from T1 to T3 (P < 0.0001). CK-MB levels did not increase significantly from T1 to T3 (P = 0.51).Conclusions: BNP levels rise progressively after DFT accompanied by early CK-MB increases and sustained increases in cTnI. These data suggest that DFT is associated with hemodynamic stress and left ventricular dysfunction, as evidenced by increases in BNP. (PACE 2012; 35: 314-319)