The Universal Definition and Classification of Heart Failure consensus has proposed the universal definition, classification and staging criteria of heart failure. The prevalence of heart failure is still increasing, and the phenotype of heart failure with preserved ejection fraction (HFpEF) is becoming more and more common. Neuro-endocrine antagonists are effective in treating patients with heart failure with reduced ejection fraction (HFrEF). However, there is no effective drug that can improve the clinical prognosis of patients with HFpEF. The pathophysiological mechanism of HFpEF involves metabolic-inflammatory mechanism disorders, epicardial fat tissue accumulation, and coronary microvascular dysfunction. The exploratory treatment of these mechanisms requires further research to confirm whether it is beneficial to patients with HFpEF. In addition, the improvement of ejection fraction and the recovery of cardiac function in patients with HFrEF after treatment cannot interrupt the drug treatment of heart failure.
Objective To investigate the change of N-terminal pro-B-type natriuretic peptide ( NT-proBNP) levels in plasma of patients with stable chronic obstructive pulmonary disease ( COPD) at exertion. Methods Pulmonary function testing, increamental and constant cycle ergometer exercise testing were performed in 19 patients with stable COPD and 10 healthy subjects. Arterial blood gas analysis were measured at rest and maximal exertion in incremental testing. Venous blood samples were drawn both at rest and maximal exercise in constant-load exercise testing and NT-proBNP levels were measured. Results NT-proBNP levels did not change significantly during exercise in the patients with stable COPD[ ( 4803. 86 ±1027. 07 ) ng/L vs ( 4572. 39 ±1243. 33 ) ng /L, P = 0. 542 ] and the control group [ ( 4303. 18 ±771. 74) ng/L vs ( 4475. 71 ±1025. 50) ng /L, P = 0. 676] . NT-proBNP levels were not correlated with parameters of cardiopulmonary exercise testing. Conclusion The factors other than cardiac function may contribute to the exercise intolerance in stable COPD patients without heart failure.
Objective To systematically evaluate the effectiveness and accuracy of brain natriuretic peptide (BNP) for predicting postoperative cardiovascular events of non-cardiac surgery. Methods Databases including The Cochrane Library, PubMed, Ovid, EMbase, WanFang Data and CNKI were searched electrically to collect literature published from 2000 to 2011, and relevant periodicals and references of the included studies were also manually retrieved. According to the inclusion and exclusion criteria, related cohort studies were selected, data were extracted, and quality of the included studies was evaluated by two reviewers independently. Then meta-analysis was conducted using RevMan 5.0 software. Results A total of 11 studies involving 3 649 patients were included. The results of meta-analysis showed that, compared with patients with lower BNP levels than the cut-off point before surgery, patients with higher BNP levels than the cut-off point before surgery suffered from a higher incidence of cardiovascular events, with a significant difference (OR=27.54, 95%CI 17.49 to 43.35, Plt;0.000 01), while the result of N-terminal pro-brain natriuretic peptide (NT-proBNP) was similar to that of BNP (OR=19.53, 95%CI 13.54 to 28.17, Plt;0.000 01). Conclusion Postoperative higher levels of BNP and NT-BNP can be used to predict postoperative cardiovascular events of non-cardiac surgery patients. This conclusion needs to be further proved by more high quality studies due to the quality limitation of the included studies.
ObjectiveTo explore whether nesiritide (recombinant human brain natriuretic peptide, rh-BNP) could be used to treat pulmonary artery hypertension. MethodsA 34-year-old female patient with severe symptomatic idiopathic pulmonary artery hypertension was reported, who was refractory to routine therapies, including prostacyclin. Therapy with continuous nesiritide infusion resulted in significant decrease in pulmonary vascular resistance and an improvement in dyspnea. The relevant literature was reviewed. ResultsThe clinical symptoms of this patient relieved significantly after nesiritide therapy. Literature review showed that nesiritide could increase the production of nitrogen oxides and cyclic guanosine monophosphate in the body, so as to dilate the vessels which were shrunk due to hypoxia and low down the pulmonary vascular resistance. ConclusionNesiritide is useful to treat severe pulmonary artery hypertension, and combination with phosphodiesterase type-5 inhibitors may be a brand new therapy of value.
ObjectiveTo investigate the efficacy of intravenous infusion of recombinant human brain natriuretic peptide in rheumatic heart valves patients with cardiorenal syndrome preoperatively, the function and operational results before and after treatment were compared. MethodsA randomized, single-blind, and controlled study was conducted in 60 patients characterized of rheumatic heart valves patients in our hospital from March 2012 through March 2015. There were 24 males and 36 females at average age of 52.1±8.9 years (ranged from 35-73 years). Their left ventricular ejection fraction was less than 40% and plasma creatinine was mildly or moderately raised. They were recruited into an experiment group and a control group by random digital table. The control group received continuous intravenous Dopamine and Nitroglycerin based anti-heart failure treatment (n=30). The experimental group received additional recombinant human brain natriuretic peptide for 48 hours without bolus (at a dose of 0.006 μg·kg-1·min-1, n=30). The levels of the biomarkers for cardiac and renal function between before and after treatment were compared. ResultsIn the experiment group, treatment with recombinant human brain natriuretic peptide for 48 hours had lower level of plasma NT-proBNP than the baseline level with a statistical difference (88.6±55.1 pg/ml vs. 55.0±47.6 pg/ml, P=0.014), lower level of high sensitivity creative reaction protein than the baseline level with a statistical difference (2.79±1.27 mg/l vs. 1.39±0.79 mg/l, P=0.000), more 24 hours urine output than the baseline level with a statistical difference (1 464.0±348.3 ml vs. 1 223.0±279.9 ml, P=0.005), lower level of serum cystatin-C than the baseline level with a statistical difference (0.25±0.14 mg/l vs. 0.08±0.07 mg/l, P=0.000), higher inotrope requirement within three days after operation (2.52±1.30 mg·kg-1·min-1 vs.3.36±1.15 mg·kg-1·min-1, P=0.011), less ICU stay days (4.5±1.2 days vs. 5.3±1.6 days, P=0.03). There were no statistical differences between the experiment group and the control group after treatment in cardiac function class, left ventricular ejection fraction, left ventricular end-diastolic diameter, creatinine, chest tube drainage volume, and intra-aortic balloon pumping use. ConclusionIntravenous injection of recombinant human brain natriuretic peptide in the patients with rheumatic valve disease combined with cardiorenal syndrome before operation can decrease systemic inflammation reaction and cardiac and renal function injury, and enhance operational recovery.
ObjectiveTo investigate diagnostic and prognostic value of pulmonary embolism severity index (PESI), troponin I (cTnI) and brain natriuretic peptide (BNP) in patients with acute pulmonary embolism (APE). MethodsA total of 96 patients confirmed with APE were collected from January 2010 to January 2013, and 50 cases of non-APE controls were also selected in the same period. According to the PESI scores, patients were divided into low-risk, mid-risk, and highrisk group. According to the results of cTnI and BNP, patients were divided into positive group and negative group. Then, we evaluated the diagnostic and prognostic value of the PESI score, cTnI and BNP for patients with APE. ResultsFor the APE patients, the higher the risk was, the higher the constituent ratio of massive and sub-massive APE was (P<0.01). In the cTnI positive group, massive and sub-massive APE accounted for 82.9%, and in the cTnI negative group, non-massive APE was up to 81.9%; in the BNP positive group, massive and sub-massive APE accounted for 73.3%, and in the BNP negative group, non-massive APE was up to 86.3%. The patients with positive cTnI and BNP had a higher rate of right ventricular dysfunction, cardiogenic shock and mortality than the negative group (P<0.01). ConclusionThe combined detection of cTnI, BNP and PESI score is important in the diagnosis and risk stratification in APE patients.
Objective To investigate the prognostic value of troponin I ( cTNI) , brain natriuretic peptide ( BNP) and D-dimer in acute pulmonary embolism ( APE) .Methods The plasma levels of cTNI, BNP, and D-dimer were measured in 98 consecutive patients with APE at the time of admission. The relationship between these parameters and mortality were evaluated. Results APE was diagnosed in 98 consecutive patients during January 2009 to December 2010, in which 49 were males and 49 were females. 14 ( 14. 3% ) patients died at the end of follow-up. The patients with positive cTNI tests had more rapid heart rates, higher rate of syncope, cardiogenic shock and mortality than the patients with normal serumcTNI. However the age and blood pressure were lower in the patients with abnormal serum cTNI ( P lt; 0. 05) . A receiver-operating characteristic curve analysis identified BNP≥226. 5 ng/L was the best cut-off value ( AUC 0. 829, 95% CI 0. 715-0. 942) with the negative predictive value of 97. 1% for death. The mortality of the patients whose serum D-dimer level ranging from 500 to 2499 ng/mL, 2500 to 4999 ng/mL, and ≥5000 ng/mL was 7. 8% , 12% , and 41. 2% , respectively ( P = 0. 009) . Upon multivariate analysis, cardiogenic shock ( OR=2. 931, 95% CI 0. 828-12. 521, P =0.000) , cTNI≥0. 3 ng/mL ( OR=1. 441, 95% CI 0. 712-4. 098, P = 0. 0043) , BNP gt; 226. 5 ng/L ( OR = 1. 750, 95% CI 0. 690-6. 452, P = 0. 011) and D-dimer≥5000 ng/mL( OR = 1. 275, 95% CI 0. 762-2. 801, P = 0. 034) were independent predictors of death. Conclusions Combined monitoring of cTNI, BNP or D-dimer levels is helpful for prognosis prediction and treatment decision for APE patients.
Objective To evaluate the efficacy of recombinant human brain natriuretic peptide (rhBNP) on Chinese patients with congestive heart failure by meta analysis. Methods Both foreign language databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2009) and Chinese databases involving CBM, VIP and CJFD were searched to identify randomized controlled trials (RCTs) that reported the effect of rhBNP on the heart function (left ventricular ejection fraction (LVEF) and the recent level of improvement in cardiac function) and its side effects of Chinese patients with congestive heart failure. Two reviewers assessed the quality of each trial and extracted data independently. The Cochrane Collaboration’s RevMan 4.2.8 software was used for statistical analysis. Results Nineteen RCTs were included, all of which came from internal. The methodological quality of the included studies was good. The baseline data of each trial were comparable. The results of meta-analyses showed: (1) the improvement of LVEF was higher in the rhBNP group than that in the blank control group (WMD=7.22, 95%CI 3.15 to 11.291, P=0.000 5). The level of improvement in cardiac function was better in the rhBNP group than those in the blank control group (OR=5.48, 95%CI 1.61 to 18.65, P=0.007), the nitroglycerin group (OR=3.60, 95%CI 2.02 to 6.41, Plt;0.000 1), and the sodium nitroprusside group (OR=3.21, 95%CI 0.12 to 85.20, P=0.49). The incidence of side effects was lower in the rhBNP group than that in the nitroglycerin group (OR=0.23, 95%CI 0.11 to 0.47, Plt;0.000 1), and the sodium nitroprusside group (OR=0.30, 95%CI 0.11 to 0.82, P=0.02). Moreover, the results of sensitivity analysis were also consistent with the above findings. Conclusion Recombinant human brain natriuretic peptide can effectively improve the hemodynamics and cardiac function level of Chinese population of patients with heart failure. The treatment doses are safe and tolerant, so it is recommended to clinical use.
Objective To investigate the value and significance of the changes of plasma level of brain natriuretic peptide（BNP） in evaluating ventricle performance of functional single ventricle after total cavopulmonary connection （TCPC）. Methods We studied 11 patients with functional single ventricle undergone TCPC procedure after 2.1 years, who were followed-up at our ward between April 2004 and November 2004, 7 of them were males and 4 of them were females （TCPC group）. The clinical heart function of patients was scored according to the modified scoring system described by Ross. We obtained 3ml blood samples from the extremital vein of all subjects. Blood was collected into chilled tubes containing EDTA and aprotinin （4.5mg and 1 500u/ml blood, respectively）. The blood samples were promptly centrifuged （-4℃, 3 000r/min for 10 min） and the plasma was separated. BNP concentration was determined using immunoradiometric assay kits. Magnetic resonance imaging （MRI） examination was undertaken in 6 patients of TCPC group to analyse the relative factors with the change of BNP. Control group included 9 healthy children. Results （1） Median plasma BNP level for TCPC group and control group was 400pg/ ml （IQR200-690） and 110 pg/ml （IQR90-190）, respectively. There was a significant difference in plasma BNP between them （P=0. 003）. （2） The results of the index of heart function of TCPC group determined by MRI were 65. 76±8. 65 ml/m2 in end-diastolic volume index, 31. 90±6. 36ml/m2 in end-systolic volume index, 39.09±11.76ml/m2 in stroke volume index, 0. 52± 0. 06 in ejection fraction（EF）, 2.38±0.58L/min·m2 in cardiac index （CI）, 103.49±21.57g/m2 in mass index and 1.57±0.24 in mass/EDV. （3） The plasma BNP level for TCPC group was significant correlation with operation ages（r=0.632, P=0.041 ）. There was no correlation between plasma BNP level with EF, CI, score of Ross, gender, ages, percutaneous oxygen saturation（SpO2） and the type of dominant ventricle, respectively. Conclusions Raised concentration of plasma BNP in patients 2 years after undertaken TCPC procedure indicates that nervous-endosecretory system is still under stress condition. This pattern suggests that neurohormonal activation is primarily related to the altered postoperative physiology. the significance of BNP in patients of functional single ventricle after undertaken TCPC is different from tat in biventricular physiology patiens. The plasma BNP level could not be correctly evaluated the cardiac function after TCPC operation.
ObjectiveTo explore the relevance of the ratio of pulmonary arterial diameter to aortic diameter exceeding one (PA:A>1) with brain natriuretic peptide (BNP) and inflammatory factor levels in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsFrom August 2013 to December 2013,95 inpatients with AECOPD in West China Hospital were divided into two groups according to the ratio of pulmonary arterial diameter to aortic diameter. The clinical data of the patients were collected. Meanwhile,arterial blood gas,plasma levels of BNP,C-reactive protein (CRP),and interleukin-6 (IL-6) within 24 hours were measured. ResultsThe plasma BNP level was 2005(483-4582)ng/L in the group with PA:A>1,and 404(137-1224)ng/L in the group with PA:A<1. There was significant difference in plasma BNP level between two groups (P<0.01). There was no significant difference in CRP or IL-6 level between two groups (P>0.05). ConclusionThe ratio of pulmonary arterial diameter to aortic diameter is correlated with BNP level in patients with AECOPD,but is not correlated with CRP or IL-6.