Predictive value for long term cardiac events by admission B-type natriuretic peptide and pulmonary capillary wedge pressure in patients with chronic heart failure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the predictive value of admission plasma B-type natriuretic peptide (BNP) and pulmonary capillary wedge pressure (PCWP) for long term cardiovascular events in patients with chronic heart failure (CHF).</p><p><b>METHODS</b>A total of 134 patients [70 males and 64 females, mean age (71.28 +/- 8.22) years] with CHF were included in this study. PCWP was measured with a Swan-Ganz catheterization and plasma BNP level was determined by a rapid immunofluorescence assay (Triage, Biosite, USA) in all patients on admission day. Left ventricular end diastolic diameter (LVEDD) and cardiothoracic ratio (CRT) were measured within 24 hours before or after catheterization. All CHF patients received conventional therapy and the rates of cardiac death and rehospitalization were used as end points during 3-year follow up.</p><p><b>RESULTS</b>(1) LVEDD, CRT, PCWP and BNP were increased in patients with cardiac events compared with patients without cardiac events (P < 0.01). (2) Multivariant logistic analysis showed that PCWP (OR = 1.423, 95% CI 1.163 - 1.741) and BNP (OR = 1.005, 95% CI 1.002 - 1.007) were the independent factors for cardiac events. (3) The area under the receiver operating curve (ROC) of BNP and PCWP to predict cardiac death was 0.846 (95% CI 0.771 - 0.922) and 0.762 (95% CI 0.666 - 0.875), respectively. The sensitivity was 76.5% and the specificity was 75.2% with BNP cutoff point of 720.5 ng/L, and the sensitivity was 68.1% and the specificity was 76.2% with PCWP cutoff point of 19.5 mm Hg (1 mm Hg = 0.133 kPa) for predicting cardiac deaths. (4) The survival rate of patients with BNP < or = 702.5 ng/L and PCWP < or = 19.5 mm Hg were significantly higher than that in patients with BNP > 702.5 ng/L (OR = 4.383, 95% CI 1.407 - 13.650) and PCWP > 19.5 mm Hg (OR = 2.843, 95% CI 1.013 - 8.854).</p><p><b>CONCLUSION</b>Both plasma BNP and PCWP on admission day are independent predictors for long term cardiac events in patients with CHF.</p>

Correlation between B-natriuretic peptide and hemodynamics in patients with decompensated heart failure and clinical significance / 中华心血管病杂志

<p><b>OBJECTIVE</b>To determine the correlation between the serum level of B-natriuretic peptide (BNP) and hemodynamic variables and to evaluate the diagnostic value of BNP in patients with decompensated heart failure (HF).</p><p><b>METHODS</b>BNP levels (TRIAGE BIOSITE Diagnostics, San Diego, USA) were obtained by a rapid immunofluorescence assay in 117 patients with dyspnea including cardiogenic group (75 patients) and lung disease (42 patients). Hemodynamic parameters of 53 patients [male 28, female 25, mean age (71.6 +/- 9.8) years] with HF were determined and left ventricular end-diastolic diameter (LVEDD) of all patients were measured by echocardiogram.</p><p><b>RESULTS</b>Pulmonary capillary wedge pressure (PCWP, mm Hg), mean pulmonary arterial pressure (MPAP, mm Hg), right atrial pressure (RAP, mm Hg) and BNP (ng/L) levels according to New York Heart Association (NYHA) class were: 16.10 +/- 3.50, 22.50 +/- 4.68, 3.11 +/- 1.90, 271.25 +/- 159.29 in NYHA class II, respectively; 21.50 +/- 4.42, 28.60 +/- 9.35, 8.95 +/- 3.86, 619.58 +/- 237.48 in NYHA class III; 29.28 +/- 8.61, 36.50 +/- 12.32, 15.27 +/- 4.96, 1519.28 +/- 618.62 in NYHA class IV (P < 0.01-0.05), respectively. PCWP, MPAP, RAP and plasma BNP levels were directly proportional to cardiac function. The plasma BNP levels had also significant positive correlations with PCWP, MPAP, RAP, (r = 0.59, 0.50, 0.32, P < 0.05-0.01). BNP level [(918.48 +/- 453.25) ng/L] of the group with LVEDD (n = 24) > or = 60 mm was much higher than that of the group with LVEDD (n = 29) < 60 mm [(298.58 +/- 167.51) ng/L]. However, the latter was significantly higher than that in pulmonary dyspnea group with a normal left and right ventricular end-diastolic diameter [(35.4 +/- 26.4) ng/L, P < 0.01]. There was a great difference of BNP between cardiogenic dyspnea group [(761.30 +/- 480.47) ng/L]and lung dyspnea group [(35.4 +/- 26.4) ng/L], P < 0.01.</p><p><b>CONCLUSIONS</b>The plasma BNP levels had significant positive correlations with PCWP, MPAP, RAP. BNP is a cardiac neurohormone secreted from cardiac ventricles as a response to ventricular volume expansion and pressure overload. Rapid testing BNP should be of help to differentiate pulmonary dyspnea from cardiac etiologies.</p>