N-Terminal Pro-B-type Natriuretic Peptide and Its Correlation to Haemodialysis-Induced Myocardial Stunning
N-Terminal Pro-B-type Natriuretic Peptide and Its Correlation to Haemodialysis-Induced Myocardial Stunning
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DOI：
10.1159/000351190
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发表时间：
2013-01-01
影响因子：
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通讯作者：
McIntyre, Christopher W.
中科院分区：
文献类型：
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作者：
Breidthardt, Tobias;Burton, James O.;McIntyre, Christopher W.
背景：血液透析（HD）能够诱发复发性心肌缺血和节段性左心室功能障碍（心肌顿抑）。 N 末端 B 型利钠肽 (NTpro-BNP) 与 HD 引起的心肌顿抑之间的关系尚不清楚。方法：在 70 名 HD 患者中，在基线时和 12 个月后通过超声心动图评估 HD 引起的心肌顿抑。将透析前 NTpro-BNP 与 HD 诱导的心肌顿抑发生的相关程度作为主要终点进行评估。结果：该队列中 Ntpro-BNP 浓度中位数为 2,154 pg/ml（IQR 1,224-3,014）。在任一时间点经历 HD 诱导的心肌顿抑的患者均表现出 NTpro-BNP 值升高（2,418 pg/ml，IQR，1,583-3,474 vs. 1,751 pg/ml，IQR (536-2,029)，p = 0.02）。 NTpro-BNP 水平在基线时表现出 HD 诱发昏迷的患者与在观察期间发生昏迷的患者之间没有差异 (p = 0.8)。透析开始时绘制的 NTpro-BNP 水平对于检测心肌顿抑的诊断准确性较差（ROC 曲线下面积 0.61，95% CI 0.45-0.77），但在随后的一年中提供了心肌顿抑的准确排除（AUC 0.85，95% CI 0.70-0.99）。计算得出的临界值 1,570 pg/ml 在任何时间点排除心肌顿抑的敏感性为 66%，特异性为 78%。在逻辑回归分析中，只有较低的 NTpro-BNP 水平（每增加 100 pg/ml，OR 为 0.92，95% CI 0.85-0.99，p = 0.03）与任何时间点没有发生心肌顿抑显着相关。结论：透析前 NTpro-BNP 水平无法充分诊断当前透析引起的心肌顿抑，但有助于识别在未来 12 个月内任何时间有发生透析引起的心肌顿抑倾向的患者。版权所有 (C) 2013 S. Karger AG，巴塞尔
Background: Haemodialysis (HD) is able to induce recurrent myocardial ischemia and segmental left-ventricular dysfunction (myocardial stunning). The association of N-terminal Pro-B-type natriuretic peptide (NTpro-BNP) with HD-induced myocardial stunning is unclear. Methods: In 70 prevalent HD patients, HD-induced myocardial stunning was assessed echocardiographically at baseline and after 12 months. The extent to which pre-dialysis NTpro-BNP was associated with the occurrence of HD-induced myocardial stunning was assessed as the primary endpoint. Results: The median Ntpro-BNP concentration in this cohort was 2,154 pg/ml (IQR 1,224-3,014). Patients experiencing HD-induced myocardial stunning at either time point displayed elevated NTpro-BNP values (2,418 pg/ml, IQR, 1,583-3,474 vs. 1,751 pg/ml, IQR (536-2,029), p = 0.02). NTpro-BNP levels did not differ between patients showing HD-induced stunning at baseline and those developing stunning during the observational period (p = 0.8). NTpro-BNP levels drawn at the beginning of the dialysis session achieved a poor diagnostic accuracy for the detection of myocardial stunning (area under the ROC curve 0.61, 95% CI 0.45-0.77), but provided an accurate rule out for myocardial stunning during the subsequent year (AUC 0.85, 95% CI 0.70-0.99). The calculated cut-off of 1,570 pg/ml achieved a sensitivity of 66% and a specificity of 78% for the exclusion of myocardial stunning at any time point. In logistic regression analysis, only low NTpro-BNP levels (OR 0.92 for every additional 100 pg/ml, 95% CI 0.85-0.99, p = 0.03) were significantly associated with absence of myocardial stunning at any time point. Conclusion: Predialytic NTpro-BNP levels fail to adequately diagnose current dialysis-induced myocardial stunning, but help to identify patients with a propensity to develop dialysis-induced myocardial stunning at any time during the next 12 months. Copyright (C) 2013 S. Karger AG, Basel