Background Stress echocardiography is mainly used in detection of coronary artery disease （CAD） and to assess risk.This study aimed to use adenosine stress echocardiography （ASE） and N-terminal pro-B-type natriure...Background Stress echocardiography is mainly used in detection of coronary artery disease （CAD） and to assess risk.This study aimed to use adenosine stress echocardiography （ASE） and N-terminal pro-B-type natriuretic peptide （NT-proBNP） to noninvasively assess coronary stenosis in patients with chest pain syndromes or anginal equivalent.Methods NT-proBNP was measured after overnight fast in fifty patients, 42 males and 8 females, who were （57＋11）years old. They then underwent echocardiography before and during adenosine administration. Left ventricular （LV）diastolic function analyzed included mitral annular early （E＇） and late velocity （A＇） both at the mitral septal and lateral level and the mitral inflow to annulus ratio （E/E＇）. Coronary angiography was performed the following day after which patients were assigned to three groups： normal results （16 patients）, stenosis 50%-69%（17 patients） and stenosis≥70% （17 patients）.Results NT-proBNP levels in the groups of stenosis 50%-69% and≥ 70% were significantly higher than that in the group with normal results （P=0.014 and P=0.040）. During adenosine stress, the E/E＇ in the group of stenosis≥70% was higher than in the group of normal results （P=0.024）. E＇lateral/A＇lateral in the group of stenosis 50%-69% and E＇septal/A＇septal and E＇lateral/A＇lateral in the group of stenosis≥70% were also decreased during stress compared with baseline （P=0.003,P=0.001, P=0.022）. The variation of E＇septal/A＇septal before and during adenosine stress （△E＇septal/A＇septal） between the groups of normal results and stenosis ≥70% were significantly different （P=0.001）. By receiver operating characteristic （ROC）, the specificity of △E＇septal/A＇septal ≥0.037 predicting coronary stenosis ＜70% was 94%. The sensitivity and specificity of NT-proBNP≥544.6 fmol/ml in predicting coronary stenosis ≥70% were 93% and 75%, respectively.NT-proBNP inversely correlated with E＇lateral/A＇lateral （r=-0.390, P=0.014） and positively correlated with E/E＇lateral（r=0.550,P=0.001）.Conclusions Adenosine might induce diastolic dysfunction in patients with coronary stenosis more than 70% and NT-proBNP could reflect LV diastolic function to a certain extent. We support the prediction that most patients having chest pain syndromes or anginal equivalent with NT-proBNP＜544.6 fmol/ml and in ASE AE＇septal/A＇septal≥0.037 might be spared coronary angiography.展开更多
Heart failure,the final outcome of various heart diseases,has an increasingly high prevalence in China.Diagnosis,medical treatments,and community managements of heart failure are substantial clinical challenges.N-term...Heart failure,the final outcome of various heart diseases,has an increasingly high prevalence in China.Diagnosis,medical treatments,and community managements of heart failure are substantial clinical challenges.N-terminal-pro-B-type natriuretic peptide （NT-proBNP） is a useful biomarker for diagnostic and prognostic predictions in heart failure patients;however,the levels of reference value in normal Chinese populations are lacking.The usage of classic Western medicines has greatly improved;furthermore,the treatment pattem of the integration of Western treatments and traditional Chinese medicine （TCM） is also widely explored.Moreover,community managements of heart failure have been paid more attention and the long-term mechanism is being built.Here,we summarize the range of reference values of NT-proBNP in normal Chinese subjects,current therapies including Western treatments and especially TCM,as well as community care among people with chronic heart failure patients in China.Keywords：chronic heart failure; N-terminal-pro-B-type natriuretic peptide; pharmacology; community care展开更多
Objective:Early identification of acute kidney injury(AKI)is essential to improve the prognosis of patients with acute heart failure(AHF).We aimed to determine the utility of neutrophil/lymphocyte ratio(NLR),N-termina...Objective:Early identification of acute kidney injury(AKI)is essential to improve the prognosis of patients with acute heart failure(AHF).We aimed to determine the utility of neutrophil/lymphocyte ratio(NLR),N-terminal prohormone of brain natriuretic peptide(NT-proBNP),urea,and creatinine(Cr),as well as combinations of these,for the prediction of AKI in patients with AHF.Methods:A total of 153 patients with AHF under the care of Sun Yat-sen Memorial Hospital,Sun Yat-sen University from October 2009 to October 2019 were included in this retrospective observational study.Their NLR,NT-proBNP,urea,and Cr concentrations were measured on admission.AKI was defined using the Acute Kidney Injury Network criteria.Receiver operating characteristic(ROC)curves,the areas under the curves(AUCs),sensitivity,and specificity were employed to evaluate the ability of each biomarker and their combinations to identify AKI.This study was approved by the Ethics Committee of Sun Yat-sen Memorial Hospital,Sun Yat-sen University(approval No.SYSEC-KY-KS-2021-126)on June 22,2021.Results:Forty-six(30.1%)participants developed AKI during hospitalization.The NLR and NT-proBNP of the participants with AKI were higher than those without(NLR:median 7.886 vs 4.717,P<0.0001;NT-proBNP,median 6774 vs 2786pg/mL,P<0.0001).ROC analyses demonstrated that high NLR and NT-proBNP were associated with higher incidences of AKI(NLR:cut-off 5.681,AUC 0.716,sensitivity 58.9%,specificity 80.4%;NT-proBNP:cut-off 5320pg/mL,AUC 0.700,sensitivity 72.9%,specificity 65.2%).Moreover,a combination of NLR,NT-proBNP,urea,and Cr yielded an AUC of 0.815,sensitivity 80.4%,and specificity of 74.8%.In addition,the AUCs for the prediction of AKI in the participants with New York Heart Association(NYHA)classes II,III,and IV were 0.936,0.860,and 0.772,respectively,using this combination.Conclusion:A combination of NLR,NT-proBNP,urea,and Cr,measured at admission,may represent a promising tool for the prediction of AKI in patients with AHF.This method performs best for AKI risk assessment in patients with NYHA II,followed by those with NYHA III or IV.展开更多
Background N-terminal-pro-brain natriuretic peptide(NT-pro-BNP)is associated with worse outcome in patients with acute myocardial infarction(AMI). However,the role of short-term follow-up of NT-pro-BNP level remains u...Background N-terminal-pro-brain natriuretic peptide(NT-pro-BNP)is associated with worse outcome in patients with acute myocardial infarction(AMI). However,the role of short-term follow-up of NT-pro-BNP level remains unclear. Methods Three hundred and sixty-two patients diagnosed with AMI were retrospectively enrolled in this study from March 2014 to March 2017 in our center. Blood samples were obtained at initial admission and again within 1 month after hospital discharge. The univariate and multivariate cox regression analyses including significant covariables were performed on NT-pro-BNP level at admission,discharge,or change from admission to discharge to predict adverse cardiovascular events(MACE)as study endpoints. Results There were 211 cases in NT-pro-BNP decrease group,while 151 cases in NT-pro-BNP increase group. The median follow-up was 365 days(interquartile range[IQR],322-861 days). After adjusting the covariables in the multiple logistic regression analysis,follow-up NT-pro-BNP level was still a significant independent predictor for MACE(OR,1.395;95% CI,1.102-1.869,P=0.005). However,the initial NT-pro-BNP level or change of NT-pro-BNP level had no significant predictive value for MACE. Conclusions A short-term follow-up NT-pro-BNP level after hospital discharge is a powerful prognostic biomarker for MACE in patients with AMI.[S Chin J Cardiol 2019;20(3):168-173]展开更多
目的探讨血浆N末端B型钠尿肽前体(N-terminal pro-B-type natriuretic peptide,NTproBNP)在预测中重度支气管肺发育不良(bronchopulmonary dysplasia,BPD)风险中的临床价值。方法采用前瞻观察性研究方法,选择2021年6月—2022年12月福建...目的探讨血浆N末端B型钠尿肽前体(N-terminal pro-B-type natriuretic peptide,NTproBNP)在预测中重度支气管肺发育不良(bronchopulmonary dysplasia,BPD)风险中的临床价值。方法采用前瞻观察性研究方法,选择2021年6月—2022年12月福建省妇幼保健院新生儿科收治的胎龄<30周极/超早产儿95例。分别于出生后第1、7、14、21天检测NTproBNP水平并收集住院期间基本资料,根据美国国家儿童健康与人类发展研究所(National Institute of Child Health and Human Development,NICHD)诊断标准,分为无-轻度BPD组(n=74)和中-重度BPD组(n=21)。比较2组不同时间点NTproBNP水平。结果中-重度BPD组胎龄、出生体质量均低于无-轻度BPD组(P<0.05);中-重度BPD组胎膜早破>18 h、≥3级新生儿呼吸窘迫综合征(respiratory distress syndrome,RDS)、有创机械通气时间>7 d、症状性动脉导管未闭(symptomatic patent ductus arteriosus,sPDA)、晚发型败血症、早产儿视网膜病(retinopathy of prematurity,ROP)的发生率均高于无-轻度BPD组,差异有统计学意义(P<0.05)。无-轻度BPD组NTproBNP水平在出生后第1天最高,中-重度BPD组NTproBNP水平在出生后第7天最高,随后逐渐降低。中-重度BPD组各时间点NTproBNP水平均高于无-轻度BPD组,差异有统计学意义(P<0.05)。出生后第1天NTproBNP水平为5631.52 pg/mL,是中重度BPD最佳预测参考值,受试者工作特征(receiver operating characteristic,ROC)曲线下面积为0.89(95%CI0.83~0.95),诊断准确性为85.71%。结论出生后第1天NTproBNP水平有助于早期预测中重度BPD发病风险,动态监测NTproBNP趋势可能对疾病防治提供一定参考价值。展开更多
文摘Background Stress echocardiography is mainly used in detection of coronary artery disease （CAD） and to assess risk.This study aimed to use adenosine stress echocardiography （ASE） and N-terminal pro-B-type natriuretic peptide （NT-proBNP） to noninvasively assess coronary stenosis in patients with chest pain syndromes or anginal equivalent.Methods NT-proBNP was measured after overnight fast in fifty patients, 42 males and 8 females, who were （57＋11）years old. They then underwent echocardiography before and during adenosine administration. Left ventricular （LV）diastolic function analyzed included mitral annular early （E＇） and late velocity （A＇） both at the mitral septal and lateral level and the mitral inflow to annulus ratio （E/E＇）. Coronary angiography was performed the following day after which patients were assigned to three groups： normal results （16 patients）, stenosis 50%-69%（17 patients） and stenosis≥70% （17 patients）.Results NT-proBNP levels in the groups of stenosis 50%-69% and≥ 70% were significantly higher than that in the group with normal results （P=0.014 and P=0.040）. During adenosine stress, the E/E＇ in the group of stenosis≥70% was higher than in the group of normal results （P=0.024）. E＇lateral/A＇lateral in the group of stenosis 50%-69% and E＇septal/A＇septal and E＇lateral/A＇lateral in the group of stenosis≥70% were also decreased during stress compared with baseline （P=0.003,P=0.001, P=0.022）. The variation of E＇septal/A＇septal before and during adenosine stress （△E＇septal/A＇septal） between the groups of normal results and stenosis ≥70% were significantly different （P=0.001）. By receiver operating characteristic （ROC）, the specificity of △E＇septal/A＇septal ≥0.037 predicting coronary stenosis ＜70% was 94%. The sensitivity and specificity of NT-proBNP≥544.6 fmol/ml in predicting coronary stenosis ≥70% were 93% and 75%, respectively.NT-proBNP inversely correlated with E＇lateral/A＇lateral （r=-0.390, P=0.014） and positively correlated with E/E＇lateral（r=0.550,P=0.001）.Conclusions Adenosine might induce diastolic dysfunction in patients with coronary stenosis more than 70% and NT-proBNP could reflect LV diastolic function to a certain extent. We support the prediction that most patients having chest pain syndromes or anginal equivalent with NT-proBNP＜544.6 fmol/ml and in ASE AE＇septal/A＇septal≥0.037 might be spared coronary angiography.
基金This work was funded by the National Natural Science Foundation of China （No.81170221） and the Key Project of Scientific Research from the Shanghai Municipality Education Commission （No.12ZZ002）.
文摘Heart failure,the final outcome of various heart diseases,has an increasingly high prevalence in China.Diagnosis,medical treatments,and community managements of heart failure are substantial clinical challenges.N-terminal-pro-B-type natriuretic peptide （NT-proBNP） is a useful biomarker for diagnostic and prognostic predictions in heart failure patients;however,the levels of reference value in normal Chinese populations are lacking.The usage of classic Western medicines has greatly improved;furthermore,the treatment pattem of the integration of Western treatments and traditional Chinese medicine （TCM） is also widely explored.Moreover,community managements of heart failure have been paid more attention and the long-term mechanism is being built.Here,we summarize the range of reference values of NT-proBNP in normal Chinese subjects,current therapies including Western treatments and especially TCM,as well as community care among people with chronic heart failure patients in China.Keywords：chronic heart failure; N-terminal-pro-B-type natriuretic peptide; pharmacology; community care
基金supported by grants from Guangdong Science and Technology Department(No.2020B1212060018)National Key Program of the Ministry of Science and Technology Foundation of China(No.2020YFC2004505)+2 种基金Guangdong Provincial Natural Science Foundation(No.2020A1515011467)Guangzhou City Science and Technology Project Plan Foundation(No.202002030149)National Natural Science Foundation of China(No.82002203).
文摘Objective:Early identification of acute kidney injury(AKI)is essential to improve the prognosis of patients with acute heart failure(AHF).We aimed to determine the utility of neutrophil/lymphocyte ratio(NLR),N-terminal prohormone of brain natriuretic peptide(NT-proBNP),urea,and creatinine(Cr),as well as combinations of these,for the prediction of AKI in patients with AHF.Methods:A total of 153 patients with AHF under the care of Sun Yat-sen Memorial Hospital,Sun Yat-sen University from October 2009 to October 2019 were included in this retrospective observational study.Their NLR,NT-proBNP,urea,and Cr concentrations were measured on admission.AKI was defined using the Acute Kidney Injury Network criteria.Receiver operating characteristic(ROC)curves,the areas under the curves(AUCs),sensitivity,and specificity were employed to evaluate the ability of each biomarker and their combinations to identify AKI.This study was approved by the Ethics Committee of Sun Yat-sen Memorial Hospital,Sun Yat-sen University(approval No.SYSEC-KY-KS-2021-126)on June 22,2021.Results:Forty-six(30.1%)participants developed AKI during hospitalization.The NLR and NT-proBNP of the participants with AKI were higher than those without(NLR:median 7.886 vs 4.717,P<0.0001;NT-proBNP,median 6774 vs 2786pg/mL,P<0.0001).ROC analyses demonstrated that high NLR and NT-proBNP were associated with higher incidences of AKI(NLR:cut-off 5.681,AUC 0.716,sensitivity 58.9%,specificity 80.4%;NT-proBNP:cut-off 5320pg/mL,AUC 0.700,sensitivity 72.9%,specificity 65.2%).Moreover,a combination of NLR,NT-proBNP,urea,and Cr yielded an AUC of 0.815,sensitivity 80.4%,and specificity of 74.8%.In addition,the AUCs for the prediction of AKI in the participants with New York Heart Association(NYHA)classes II,III,and IV were 0.936,0.860,and 0.772,respectively,using this combination.Conclusion:A combination of NLR,NT-proBNP,urea,and Cr,measured at admission,may represent a promising tool for the prediction of AKI in patients with AHF.This method performs best for AKI risk assessment in patients with NYHA II,followed by those with NYHA III or IV.
文摘Background N-terminal-pro-brain natriuretic peptide(NT-pro-BNP)is associated with worse outcome in patients with acute myocardial infarction(AMI). However,the role of short-term follow-up of NT-pro-BNP level remains unclear. Methods Three hundred and sixty-two patients diagnosed with AMI were retrospectively enrolled in this study from March 2014 to March 2017 in our center. Blood samples were obtained at initial admission and again within 1 month after hospital discharge. The univariate and multivariate cox regression analyses including significant covariables were performed on NT-pro-BNP level at admission,discharge,or change from admission to discharge to predict adverse cardiovascular events(MACE)as study endpoints. Results There were 211 cases in NT-pro-BNP decrease group,while 151 cases in NT-pro-BNP increase group. The median follow-up was 365 days(interquartile range[IQR],322-861 days). After adjusting the covariables in the multiple logistic regression analysis,follow-up NT-pro-BNP level was still a significant independent predictor for MACE(OR,1.395;95% CI,1.102-1.869,P=0.005). However,the initial NT-pro-BNP level or change of NT-pro-BNP level had no significant predictive value for MACE. Conclusions A short-term follow-up NT-pro-BNP level after hospital discharge is a powerful prognostic biomarker for MACE in patients with AMI.[S Chin J Cardiol 2019;20(3):168-173]
文摘目的探讨血浆N末端B型钠尿肽前体(N-terminal pro-B-type natriuretic peptide,NTproBNP)在预测中重度支气管肺发育不良(bronchopulmonary dysplasia,BPD)风险中的临床价值。方法采用前瞻观察性研究方法,选择2021年6月—2022年12月福建省妇幼保健院新生儿科收治的胎龄<30周极/超早产儿95例。分别于出生后第1、7、14、21天检测NTproBNP水平并收集住院期间基本资料,根据美国国家儿童健康与人类发展研究所(National Institute of Child Health and Human Development,NICHD)诊断标准,分为无-轻度BPD组(n=74)和中-重度BPD组(n=21)。比较2组不同时间点NTproBNP水平。结果中-重度BPD组胎龄、出生体质量均低于无-轻度BPD组(P<0.05);中-重度BPD组胎膜早破>18 h、≥3级新生儿呼吸窘迫综合征(respiratory distress syndrome,RDS)、有创机械通气时间>7 d、症状性动脉导管未闭(symptomatic patent ductus arteriosus,sPDA)、晚发型败血症、早产儿视网膜病(retinopathy of prematurity,ROP)的发生率均高于无-轻度BPD组,差异有统计学意义(P<0.05)。无-轻度BPD组NTproBNP水平在出生后第1天最高,中-重度BPD组NTproBNP水平在出生后第7天最高,随后逐渐降低。中-重度BPD组各时间点NTproBNP水平均高于无-轻度BPD组,差异有统计学意义(P<0.05)。出生后第1天NTproBNP水平为5631.52 pg/mL,是中重度BPD最佳预测参考值,受试者工作特征(receiver operating characteristic,ROC)曲线下面积为0.89(95%CI0.83~0.95),诊断准确性为85.71%。结论出生后第1天NTproBNP水平有助于早期预测中重度BPD发病风险,动态监测NTproBNP趋势可能对疾病防治提供一定参考价值。
