Utility of B-type natriuretic peptide (BNP) as a screen for left ventricular dysfunction in patients with diabetes
Utility of B-type natriuretic peptide (BNP) as a screen for left ventricular dysfunction in patients with diabetes
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DOI：
10.2337/diacare.26.7.2081
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发表时间：
2003-07-01
期刊：
影响因子：
16.2
通讯作者：
Maisel, A
中科院分区：
文献类型：
--
作者：
Epshteyn, V;Morrison, K;Maisel, A
目的-常规超声心动图筛查糖尿病患者是不可行的，由于其有限的可用性和高成本。B型利钠肽（BNP）是从左心室分泌的压力超负荷反应，并在收缩和舒张功能不全升高。研究设计和方法- BNP水平进行了比较，超声心动图的结果在263例。将患者分为有超声心动图检查临床指征（CIE）组（n = 172）和无超声心动图检查临床指征（no-CIE）组（n = 91）。心脏病专家在测量血浆BNP水平时对左心室功能进行评估是不知情的。结果-91例无回声CIE患者的BNP水平（83 +/- 16 pg/ml）与215例无回声CIE患者的BNP水平（63 +/- 10，P = 0.10）相似。CIE和随后的左心室功能异常患者（n = 112）的平均BNP浓度为435 +/- 41 pg/ml，与无CIE的患者相比，但超声心动图显示左心室功能异常（n = 32）（161 +/- 40 pg/ml）。32例无CIE但左室功能异常的患者中有21例舒张功能不全（BNP 190 ± 60 pg/ml）。受试者工作特征（ROC）曲线显示CIE患者的曲线下面积为0.91，非CIE患者的曲线下面积为0.81（P < 0.001）。对于那些没有充血性心力衰竭（CHF）症状，BNP水平显示出较高的阴性预测值（91%的BNP值90 pg/ml）。结论- BNP可以可靠地筛选糖尿病患者是否存在左心室功能障碍。
OBJECTIVE - Routine screening of diabetic patients with echocardiography is not feasible due to its limited availability and high cost. B-type natriuretic peptide (BNP) is secreted from the left ventricle in response to pressure overload and is elevated in both systolic and diastolic dysfunction.RESEARCH DESIGN AND METHODS - BNP levels were compared to echocardiographic findings in 263 patients. Patients were divided into two groups: clinical indication for echocardiography (CIE) (n = 172) and those without clinical indication for echocardiography (no-CIE) (n = 9 1). Cardiologists making the assessment of left ventricular function were blinded when measuring plasma levels of BNP.RESULTS - The 91 patients with no-CIE with echos had similar BNP levels (83 +/- 16 pg/ml) to the 215 patients with no-CIE without echos (63 +/- 10, P = 0.10). Patients with CIE and subsequent abnormal left ventricular function (n = 112) had a mean BNP concentration of 435 +/- 41 pg/ml, compared with those with no-CIE, but had abnormal left ventricular function on echo (n = 32) (161 +/- 40 pg/ml). Twenty-one of 32 patients with no-CIE but with abnormal left ventricular function had diastolic dysfunction (BNP 190 +/- 60pg/ml). A receiver-operating characteristic (ROC) curve revealed that the area under the curve was 0.91 for CIE patients and 0.81 for no-CIE patients (P < 0.001). For those with no congestive heart failure (CHF) symptoms, BNP levels showed a high negative predictive value (91% for BNP values 90 pg/ml).CONCLUSIONS - BNP can reliably screen diabetic patients for the presence or absence of left ventricular dysfunction.