Diastolic dysfunction and natriuretic peptides in systolic heart failure. Higher ANP and BNP levels are associated with the restrictive filling pattern.
Diastolic dysfunction and natriuretic peptides in systolic heart failure. Higher ANP and BNP levels are associated with the restrictive filling pattern.
复制标题
收缩性心力衰竭中的舒张功能障碍和利钠肽。
DOI：
10.1093/oxfordjournals.eurheartj.a014753
复制
发表时间：
1996
影响因子：
39.3
通讯作者：
Kamsang Woo
中科院分区：
文献类型：
--
作者：
Cheuk;J. Sanderson;I. Shum;S. Chan;L. Yeung;Y. Hung;C. Cockram;Kamsang Woo
背景
左室舒张功能障碍在收缩性心力衰竭患者中很常见，限制性充盈模式似乎与心源性死亡率增加相关。心房和脑（或心室）利钠肽也被证明是心力衰竭严重程度的标志物。本研究的目的是在一个大的收缩性心力衰竭患者队列中确定舒张期异常，特别是二尖瓣血流速度的限制性充盈模式是否与血浆心房和脑钠肽水平相关。
方法
连续68例有症状的收缩性心力衰竭（射血分数< 0.5）患者接受了左室收缩和舒张功能的二维多普勒超声心动图检查，并测量了心房和脑钠肽。
结果
限制性充盈占62%，异常充盈占31%，正常充盈仅占7%。限制性舒张组的心房和脑钠肽（ANP/BNP）水平显著高于异常舒张组（ANP：202.2 +/- 31.7 vs 102.5 +/- 22.1 pg.ml-1，P = 0.012; BNP：277.8 +/- 27.7 vs 162.4 +/- 21.9 pg.ml-1，P = 0.002）。此外，限制性充盈模式与射血分数较低（P = 0.026）、肺动脉收缩压较高（P < 0.001）、左心房较大（P = 0.044）相关，与舒张模式异常的患者相比，限制性充盈模式更可能属于纽约心脏协会III级或IV级（P = 0.007）。心房利钠肽和脑利钠肽均与射血分数（P < 0.001）、短轴缩短率（P < 0.001）呈负相关，与肺动脉压（P = 0.004和0.001）呈正相关。除二尖瓣峰值A波速度与脑钠肽水平相关外（r =-0.3，P = 0.01），所有患者组的单个舒张参数与心房或脑钠肽水平均无显著相关性。二尖瓣舒张功能异常者，E波减速时间与心钠素、脑钠素水平显著相关（P < 0.01）。
结论
本研究证实，限制性充盈模式的二尖瓣血流速度是一个更严重的心力衰竭的标志，如其与心房和脑钠肽水平较高，射血分数较低和肺动脉压较高的相关性。因此，这种容易获得的多普勒衍生的舒张功能障碍的标记物是有用的，以确定那些更严重的心力衰竭患者。
BACKGROUND
Left ventricular diastolic dysfunction is common in patients with systolic heart failure and the restrictive type of filling pattern appears to be associated with increased cardiac mortality. Both artrial and brain (or ventricular) natriuretic peptides are also proven markers of the severity of heart failure. The aim of this study was to determine in a large cohort of patients with systolic heart failure whether diastolic abnormalities, and in particular the restrictive filling pattern of transmitral flow velocity, correlate with plasma atrial and brain natriuretic peptide levels.
METHODS
Sixty-eight consecutive patients with symptomatic systolic heart failure (ejection fraction < 0.5) underwent two-dimensional Doppler echocardiography of left ventricular systolic and diastolic function, together with measurement of atrial and brain natriuretic peptides.
RESULTS
The restrictive filling pattern was present in 62%, the abnormal relaxation pattern in 31% and only 7% were normal. Atrial and brain natriuretic peptide (ANP/BNP) levels were significantly higher in the restrictive compared to the abnormal relaxation group (ANP: 202.2 +/- 31.7 vs 102.5 +/- 22.1 pg.ml-1, P = 0.012; BNP: 277.8 +/- 27.7 vs 162.4 +/- 21.9 pg.ml-1, P = 0.002). In addition, a restrictive filling pattern was associated with lower ejection fractions (P = 0.026), higher pulmonary artery systolic pressure (P < 0.001), larger left atrial size (P = 0.044), and were more likely to be in New York Heart Association class III or IV than those with an abnormal relaxation pattern (P = 0.007). Both atrial and brain natriuretic peptides correlated inversely with ejection fraction (P < 0.001), fractional shortening (P < 0.001), and positively with pulmonary artery pressure (P = 0.004 and 0.001 respectively). There were no significant correlations between single diastolic parameters and atrial or brain natriuretic peptide levels for the total patient group except between mitral peak A wave velocity and brain natriuretic peptides (r = -0.3, P = 0.01). For those with abnormal relaxation pattern mitral, valve E-wave deceleration time correlated significantly with both atrial and brain natriuretic peptide levels (P < 0.01).
CONCLUSIONS
This study confirms that the restrictive filling pattern of transmitral flow velocity is a marker of more severe heart failure, as indicated by its association with higher atrial and brain natriuretic peptide levels, lower ejection fraction and higher pulmonary artery pressure. Thus, this easily obtained Doppler-derived marker of diastolic dysfunction is useful for identifying those patients with more severe heart failure.
影响因子：
37.8
作者：
WEI, CM;HEUBLEIN, DM;BURNETT, JC
通讯作者：
BURNETT, JC