Contribution of Extracardiac Factors to the Inconsistency Between Plasma B-type Natriuretic Peptide Levels and the Severity of Pulmonary Congestion on Chest X-rays in the Diagnosis of Heart Failure
Contribution of Extracardiac Factors to the Inconsistency Between Plasma B-type Natriuretic Peptide Levels and the Severity of Pulmonary Congestion on Chest X-rays in the Diagnosis of Heart Failure
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DOI：
10.2169/internalmedicine.51.6206
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发表时间：
2012-01-01
影响因子：
1.2
通讯作者：
Yoshimura, Michihiro
中科院分区：
文献类型：
--
作者：
Nakane, Tokiko;Kawai, Makoto;Yoshimura, Michihiro
目的胸部X线检查和血浆B型利钠肽（BNP）水平对充血性心力衰竭的诊断有重要价值。然而，血浆BNP水平与胸部X线肺充血之间的关系似乎往往不一致。心外因素可直接改变血浆BNP水平，与心功能无关。在本研究中，我们研究的临床因素，影响心力衰竭的诊断，通过使用胸部X射线和血浆BNP levels.Methods和结果本研究包括459例连续患者谁被接纳到我们医院的心血管科的任何原因，并在其中胸部X射线和血浆BNP水平测定入院后12小时内。与肺充血相关的BNP值约为143 pg/mL，可通过胸部X线检测，但该值受肾功能、年龄和体重指数（BMI）的影响。此外，我们还研究了这三种心外因素对肺充血各阶段血浆BNP水平的影响。发现肾功能不全和高龄可使血浆BNP水平升高，而高BMI则使血浆BNP水平降低，且重度心力衰竭患者BMI对血浆BNP水平的影响更大。结论当血浆BNP水平与胸片肺淤血严重程度的关系不一致时，应考虑心外因素。特别是，应仔细考虑高BMI患者血浆BNP水平低，以避免低估心力衰竭的程度。
Objective Chest X-rays and plasma B-type natriuretic peptide (BNP) levels are useful for diagnosing congestive heart failure. However, the relationship between plasma BNP levels and pulmonary congestion on chest X-rays often seems inconsistent. Extracardiac factors can directly alter plasma BNP levels, independent of cardiac function. In the present study, we examined the clinical factors that impact the diagnosis of heart failure by using chest X-rays and plasma BNP levels.Methods and Results This study comprised 459 consecutive patients who were admitted to the cardiovascular division of our hospital for any reason and in whom chest X-rays and plasma BNP levels were measured within 12 hours after admission. The approximate BNP value associated with pulmonary congestion that was detectable by chest X-rays was 143 pg/mL, but this value was influenced by renal function, age, and body mass index (BMI). Furthermore, we examined the effect of these three extracardiac factors on plasma BNP levels in each stage of pulmonary congestion. We found that renal dysfunction and advanced age increased the plasma BNP levels, whereas a high BMI decreased the levels, and that the effect of BMI on plasma BNP levels was greater for severe heart failure.Conclusion Extracardiac factors should be considered when the relationship between the plasma BNP levels and the severity of pulmonary congestion on chest X-rays seems inconsistent. In particular, low levels of plasma BNP in patients with a high BMI should be carefully considered to avoid underestimating the degree of heart failure.