Prognostic significance of repeated brain natriuretic peptide measurements after percutaneous transluminal septal myocardial ablation in patients with drug-refractory hypertrophic obstructive cardiomyopathy.
Prognostic significance of repeated brain natriuretic peptide measurements after percutaneous transluminal septal myocardial ablation in patients with drug-refractory hypertrophic obstructive cardiomyopathy.
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DOI：
10.1136/openhrt-2018-000786
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发表时间：
2018
期刊：
影响因子：
2.7
通讯作者：
Maekawa Y
中科院分区：
文献类型：
--
作者：
Akita K;Tsuruta H;Yuasa S;Murata M;Fukuda K;Maekawa Y
评估经皮腔内间隔心肌消融术（PTSMA）后反复脑钠肽（BNP）测量是否能提供药物难治性肥厚性梗阻性心肌病（HOCM）患者PTSMA疗效的预后信息。血浆BNP水平与HOCM患者的临床预后相关。然而，PTSMA前后血浆BNP水平变化的预后价值尚不清楚。我们连续测量47例患者PTSMA前后血浆BNP水平，并评估血浆BNP水平变化与临床改善的关系。根据PTSMA前后纽约心脏协会分级≥1（良好反应者）或<1（不良反应者）的减少将患者分为两组。采用堪萨斯城心肌病问卷（KCCQ）测量健康状况。血浆BNP水平在PTSMA后逐渐下降，尽管在PTSMA后3个月至12个月达到稳定水平。虽然两组间血浆BNP水平和静息左心室流出道峰值压力梯度具有可比性，但反应良好组PTSMA前后BNP水平之比明显低于反应不良组（0.43（范围，0.24-0.68）vs 0.78（范围，0.62-0.93），p=0.002）。反应良好组的KCCQ评分变化显著高于反应不良组。血浆BNP水平比值与药物难治性HOCM患者PTSMA后心力衰竭的长期临床改善相关。
To evaluate whether repeated brain natriuretic peptide (BNP) measurements after percutaneous transluminal septal myocardial ablation (PTSMA) provide prognostic information regarding the response to PTSMA in patients with drug-refractory hypertrophic obstructive cardiomyopathy (HOCM). Plasma BNP levels are associated with clinical outcomes in patients with HOCM. However, the prognostic value of plasma BNP level changes before and after PTSMA remains unclear. We measured the plasma BNP levels serially before and after PTSMA, and evaluated the relationship between the changes in plasma BNP levels and clinical improvement in 47 patients. The patients were assigned to two groups based on the reduction in the New York Heart Association class ≥1 (good responder) or <1 (poor responder) before and after PTSMA. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to measure health status. The plasma BNP levels gradually decreased after PTSMA, although the levels plateaued 3 months until 12 months after PTSMA. Although the plasma BNP levels and resting left ventricular outflow tract peak pressure gradient before PTSMA were comparable between the groups, the ratio of the BNP levels before and after PTSMA in the good responder group was significantly lower than that in the poor responder group (0.43 (range, 0.24–0.68) vs 0.78 (range, 0.62–0.93), p=0.002). The KCCQ score changes in the good responder group were significantly higher than those in the poor responder group. The plasma BNP level ratio was associated with long-term clinical improvement of heart failure after PTSMA for drug-refractory HOCM.