边文彦
中国医学科学院阜外医院 卫生部心血管药物临床研究重点实验室
OBJECTIVE:Heart failure is responsible for a huge burden in hospital care. Our goal was to evaluate the value of N-terminal-pro-brain natriuretic peptide (Nt-proBNP) on predicting death or hospital readmission after hospital discharge in patients with chronic heart failure (CHF).METHODS:From March 2003 to April 2005, 135 consecutive patients (97 male and 38 female, mean age 60.7 years +/- 13.1 years) with chronic heart failure [dilated cardiomyopathy (44%) and coronary heart disease (35%)] were included in this study. Plasma concentrations of the Nt-proBNP were measured by ELISA on admission. All patients received conventional therapy and were followed up for 24 months. The primary end point was death or readmission.RESULTS:(1) During the follow up period (640 days +/- 100 days), 11 patients died and 39 patients rehospitalized, the median Nt-proBNP level on admission was significantly higher in patients died during the follow up period (5908 ng/L) than that of rehospitalized patients (2768 ng/L, P = 0.038). Plasma Nt-proBNP level on admission were significantly higher in primary end point group (n = 50, 2947 ng/L) than that in non-primary end point group (n = 85, 917 ng/L, P < 0.01). (2) Variables associated with an increased hazard of death and/or rehospitalization were Nt-proBNP and NYHA degree when analyzed by logistic regression models. Increased Log Nt-proBNP was the strongest independent predictor of an adverse outcome of CHF (odds ratio 13.8, 95% confidence interval 2.29 to 2.78, P < 0.01). (3) Area under the curve for Nt-proBNP in evaluating prognosis of CHF patients was 0.885 (positive predictive value 88.5%, negative predictive value 11.5%).CONCLUSION:Nt-proBNP level on admission is a strong predictor of rehospitalization and death within 24 months after hospital discharge in patients with chronic heart failure.
Zhonghua xin xue guan bing za zhi 2006
OBJECTIVE:To study the relationship of the level of N-terminal portion of brain natriuretic (NT-ProBNP) with the treatment and prognosis of patients with acute attack of chronic left heart failure.METHODS:Patients (age range 18-80 years) with decompensated heart failure treated in the emergency department in Fuwai Hospital were included in this study. Dynamic changes of plasma levels of NT-ProBNP, angiotensin (AO), renin activity (PRA), angiotensin II (AT II) and aldosterone (ALD) were detected by enzyme linked immunoadsorbent assay (ELISA) before anti-cardiac failure treatment and 3-5, 5-7 days after the treatment. All enrolled patients were followed up for 2 years after leaving hospital, and cardiovascular events such as death, myocardial infarction, worsening of heart failure, severe arrhythmia or delayed discharge from hospital were recorded.RESULTS:Compared with baseline level at admission, plasma NT-ProBNP levels were lowered on 3rd -5th day and 5th-7th day after admission and treatment (both P<0.05) in 44 patients with chronic left heart failure, but there was no difference in NT-ProBNP levels between the 3rd-5th and 5th -7th day after treatment. The levels of plasma NT-ProBNP increased much higher at all observation times in patients with cardiovascular events than without the events (all P<0.05), but the changes in AO, PRA, ATII and ALD showed no significant difference between two groups (all P>0.05).CONCLUSION:During acute onset, plasma NT-ProBNP levels in patients with chronic left heart failure can be lowered at 3-7 days after admission and treatment. Higher baseline levels of plasma NT-ProBNP may have certain predictive values for long term prognosis in patients with chronic left heart failure.
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 2006
