B-type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure - Comparison between systolic and diastolic heart failure
B-type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure - Comparison between systolic and diastolic heart failure
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DOI：
10.1016/j.jacc.2005.11.030
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发表时间：
2006-02-21
影响因子：
24
通讯作者：
Nonogi, H
中科院分区：
文献类型：
--
作者：
Iwanaga, Y;Nishi, I;Nonogi, H
我们探索了在心力衰竭（HF）的临床环境中B型利钠肽（BNP）分泌的刺激。背景血浆BNP水平越来越多地被纳入收缩性心力衰竭（SHF）以及舒张性心力衰竭（DHF）的临床评估和管理中。然而，异质性BNP水平之间的个人与HF可能会导致一些混乱ILL解释result.METHODS在160例连续的HF患者，我们测量血浆BNP水平，并进行超声心动图和心导管检查。结果血浆BNP与左室舒张末期压（EDP）呈显著相关（r（2）= 0.296 [p < 0.001]），但与正常对照组相比，血浆BNP与EDP无显著相关性（r（2）= 0.296 [p < 0.001]），血浆BNP与EDP无显著相关性（r（2）= 0.296 [p < 0.001]）。血浆BNP与舒张末期室壁应力（EDWS）的相关性更强（r（2）= 0.987 [p < 0.001]）。在62例DHF患者的亚组分析中，获得了类似的结果（EDP的r（2）= 0.143，EDWS的r（2）= 0.704）。在SHF和DHF之间的比较中，SHF中的BNP水平显著高于DHF（p < 0.001）。尽管EDP没有显示任何差异，但SHF患者的EDWS显著高于DHF患者（p < 0.001）。结论本研究表明，血浆BNP水平比以往报道的任何其他参数更能反映左心室EDWS，不仅在SHF患者中，而且在DHF患者中。左心室EDWS与血浆BNP的关系可能为BNP水平的个体间异质性及其在HF诊断和治疗中的临床应用提供更好的基础理解。
OBJECTIVES We explored the stimulus for B-type natriuretic peptide (BNP) secretion in the clinical setting of heart failure (HF).BACKGROUND Increasingly, plasma BNP levels arc being incorporated into the clinical assessment and management of systolic heart failure (SHF) as well as diastolic heart failure (DHF). However, heterogeneity in BNP levels among individuals with HF can cause some confusion ill interpreting results.METHODS In 160 consecutive patients presenting with HF, we measured plasma BNP levels and performed echocardiography and cardiac catheterization. Systolic and diastolic meridional wall stress was calculated from echocardiographic and hemodynamic data.RESULTS Although plasma BNP had a significant correlation (r(2) = 0.296 [p < 0.001]) with left ventricular end-diastolic pressure (EDP) as previously, reported, the correlation between plasma BNP and end-diastolic wall stress (EDWS) (r(2) = 0.987 [p < 0.001]) was more robust. In a subanalysis of 62 patients with DHF, a similar result was obtained (r(2) = 0.143 for EDP and r(2) = 0.704 for EDWS). In a comparison between SHF and DHF, the BNP level was significantly higher in SHF (p < 0.001.). Although EDP did not show any difference, EDWS was significantly higher in SHF than in DHF (p < 0.001).CONCLUSIONS The present study shows that plasma BNP levels reflect left ventricular EDWS more than any other parameter previously reported, not only in patients with SHF, but also in patients with DHF. The relationship of left ventricular EDWS to plasma BNP may provide a better fundamental understanding of the interindividual heterogeneity in BNP levels and their clinical utility in the diagnosis and management of HF.