Comparison of B-type natriuretic peptide levels in patients with heart failure with versus without mitral regurgitation.
Comparison of B-type natriuretic peptide levels in patients with heart failure with versus without mitral regurgitation.
复制标题
有二尖瓣反流的心力衰竭患者与无二尖瓣反流的患者 B 型利尿钠肽水平的比较。
DOI：
10.1016/j.amjcard.2004.01.008
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
Grayburn,PaulA
中科院分区：
文献类型：
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作者：
Mayer,SusanA;DeLemos,JamesA;Murphy,SabinaA;Brooks,Sandra;Roberts,BradJ;Grayburn,PaulA
功能性二尖瓣反流(MR)最常发生于心力衰竭(HF)患者，并与不良预后相关。近年来，B型利钠肽(BNP)已被证实是心功能和预后的标志物。我们试图评估心力衰竭患者功能性MR和BNP水平之间的关系，并假设MR与较高的BNP水平相关。总共有201名确诊为心力衰竭的患者在48小时内接受了经胸超声心动图和BNP水平的测量。根据美国超声心动图学会最近发布的指南，MR被分级为无/痕迹、轻度、中度或重度。用市售仪器(Biosite)测定BNP。患者的平均年龄为67±11岁，采用托宾估计的多元线性回归方法评估MR与BNP的关系，以说明BNP值上限为1300pg/ml时的截断。患者心力衰竭的病因以舒张期为主(32%)，左心室收缩功能不全者137例(68%)。平均左心室射血分数为37±17%。112例患者(56%)出现MR。在调整了临床、血流动力学和超声心动图变量后，只有左心室射血分数(p=0.016)和中度或重度MR(p=0.023)与脑钠素显著相关。当MR分为MR组和非MR组时，只有左心室射血分数(P=0.017)和任意程度的MR(P=0.029)与BNP显著相关。
Functional mitral regurgitation (MR) occurs most often in patients with heart failure (HF) and is associated with an adverse prognosis. Recently, B-type natriuretic peptide (BNP) has been validated as a marker of cardiac function and prognosis. We sought to assess the relation between functional MR and BNP levels in patients with HF, and hypothesized that MR is associated with higher BNP levels. In all, 201 patients admitted with the diagnosis of HF had a transthoracic echocardiogram and measurement of BNP levels within 48 hours. MR was graded as none/trace, mild, moderate, or severe using recently published guidelines of the American Society of Echocardiography. BNP was measured by a commercially available instrument (Biosite). The relation of MR to BNP was assessed using multivariable linear regression methods with a Tobin estimation to account for the truncation of BNP values at an upper limit of 1,300 pg/ml. Mean age of the patients was 67 ± 11 years. The median BNP level was 826 pg/ml. The etiology of HF was predominantly diastolic in 64 patients (32%); 137 patients (68%) had significant left ventricular (LV) systolic dysfunction. Mean LV ejection fraction was 37 ± 17%. MR was present in 112 patients (56%). After adjusting for clinical, hemodynamic, and echocardiographic variables, only LV ejection fraction (p = 0.016) and moderate or severe MR (p = 0.023) were significantly associated with BNP. When MR was grouped as any MR versus no MR, only LV ejection fraction (p = 0.017) and any degree of MR (p = 0.029) were significantly associated with BNP.