Objective To explore the pulmonary arterial pressure level in patients with predialysis chronic kidney disease ( CKD) and its relationship to cardiac structure and function. Methods 397 patients with predialysis CKD and 50 healthy subjects were enrolled. Cardiac structure was evaluated by Doppler echocardiography. Glomerular filtration rate ( GFR ) were assessed by radiant 99mTc-DTPA.Differences of PAP, BNP, LA, IVST, LVDd, LVDs, LVEF, LVMI and the correlation of PAP with cardiac structure and function were examined. Results The PAP level in the predialysis CKD patients was much higher than that in the healthy subjects [ ( 33. 13 ±9. 00) mm Hg vs. ( 29. 43 ±3. 71) mmHg, P lt;0. 01] .18. 9% of the CKD patients were complicated with pulmonary hypertension. PAP was higher in the CKD patients in stages 4-5 than those CKD patients in stages 1-3 [ ( 35. 90 ±9. 34) mmHg vs. ( 32. 08 ±8. 62)mmHg, P lt;0. 01) ] , so as to the prevalene of pulmonary hypertension ( 21. 60% vs. 13. 47% , P lt;0. 01) .Compared with the healthy, the level of lnBNP [ ( 3. 59 ±1. 63) pg/mL vs. ( 2. 88 ±1. 51) pg/mL, P lt;0. 01] , LA [ ( 40. 42 ±6. 77) mmvs. ( 36. 75 ±4. 94) mm, P lt; 0. 01) ] , LVPW [ ( 9. 55 ±1. 96) mm vs.( 8. 54 ±0. 88) mm, P lt; 0. 01) ] , IVST [ ( 9. 76 ±1. 75) mm vs. ( 8. 71 ±0. 90) mm, P lt; 0. 01) ] , LVMI[ ( 105. 61 ±36. 47) g/m2 vs. ( 87. 41 ±17. 08) g/m2 , P lt; 0. 01) ] were all much higher. There was a negative correlation between PAP and GFR( r = - 0. 461, P lt;0. 01) , and positive correlations between PAP and LA ( r=0. 491, P lt; 0. 01) , LVPW ( r =0. 298, P lt;0. 01) , IVST ( r = 0. 613, P lt;0. 01) , lnBNP ( r =0. 536, P lt;0. 01) , LVMI ( r = 0. 382, P lt;0. 01) . LVMI and lnBNP were both independent risk factors of PAP. The regression equation: y = 16. 447 + 0. 105x1 + 1. 724x2 ( F = 23. 482, P = 0. 000) , y: PAP( mm Hg) , x1 : LVMI( g/m2 ) , x2 : lnBNP( pg/mL) . Conclusions Pulmonary hypertension is a common morbidity of predialysis CKD patients, and deteriorates with degression of renal function. PAP is related to indexes of cardiac structure ( LVMI, LA, LVPW, IVST) and index of cardiac function ( lnBNP) . LnBNP and LVMI are independent risk factors of PAP.
Objective To evaluate the diagnostic value of brain natriuretic peptide (BNP) for cardiac dyspnea.Methods Plasma BNP levels were measured by radioimmunoassay in dyspnea patients with chronic heart failure (CHF) (n=52) or without CHF (n=30) and normal control group (n=28).Results The BNP level in dyspnea patients with CHF was significantly higher than that of dyspnea patients without CHF and normal control group [(649.80±141.72) pg/mL vs (59.08±18.60) pg/mL and (65.20±16.32) pg/mL，respectively,Plt;0.05].There was no significant difference of BNP level between dyspnea patients without CHF and normal group (Pgt;0.05).The plasma BNP level elevated with the worsening of heart failure (NYHA Classiffication).The BNP level in dyspnea patients with CHF was negatively correlated with left ventricle ejection fraction (r=－0.673，Plt;0.001).The receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve (AUC) is 0.91(0.88-0.98，Plt;0.001) with a sensitivity of 87.2% and a specificity of 86.8% at the cutoff value of 206 pg/mL.Conclusion Measurement of plasma BNP is a rapid diagnostic method for cardiac dyspnea.
Objective To systematically evaluate the efficacy and safety of recombinant human brain natriuretic peptide (rhBNP) in preventing contrast induced nephronpathy (CIN). Methods Randomized controlled trials using rhBNP for the prevention of CIN were retrieved from China National Knowledge Infrastructure, Chongqing VIP, Wanfang, SinoMed, PubMed, Embase, Web of Science, and Cochrane Library between the establishment of databases and December 31, 2024. RevMan 5.3 software was used for meta-analysis. Results A total of 12 articles were included. The meta-analysis results showed that compared with the saline group, the rhBNP group had a lower incidence of CIN [relative risk (RR)=0.39], blood creatinine levels at 48 hours [(standardized mean difference (SMD)=−0.79] and 72 hours (SMD=−0.68), cystatin C levels at 48 hours (SMD=−0.44) and 72 hours (SMD=−0.72), incidence of adverse events (RR=0.53), and higher eGFR at 48 hours [mean difference (MD)=4.62] and 72 hours (MD=7.11) after angiography. Conclusion The rhBNP may reduce the incidence and adverse events of CIN, and alleviate renal function damage after angiography.
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.
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 investigate the correlation between plasma aminoterminal pro-B-type natriuretic peptide (NT-proBNP) level and severity of coronary artery lesions in patients with non-ST segment elevation myocardial infarction (NSTEMI). Methods NSTEMI patients presenting to the Emergency Department and Department of Cardiology from January 2013 to March 2017 were divided into four groups: thrombosis without stenosis, single vessel disease, double vessel diseases, and three vessel diseases. The general situation of the patients, the plasma NT-proBNP, troponin T, echocardiogram and coronary angiography results were analyzed. Results A total of 88 patients were included including 6 in thrombosis without stenosis group, 20 in single vessel disease group, 31 in double vessel diseases group, and 31 in three vessel diseases group. The NT-proBNP level, left ventricular ejection fraction, left ventricular end diastolic diameter, and coronary Gensini score in three vessel diseases group differed much from those in the other groups (P<0.05). The correlation of NT-proBNP with coronary Gensini score in all the patients was positve (t=0.663, P<0.05). Conclusion The level of plasma NT-proBNP in patients with NSTEMI is related to the severity of coronary artery disease.
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 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 estimate the relationship of methods and drugs for management of constrictive pericarditis during pericardiectomy. Methods We reviewed the records of 45 patients (mean age, 40.24±15.34 years) with a diagnosis of constrictive pericarditis who underwent pericardiectomy in our hospital from 2012 through 2014 year. During operation, inotropic agents, vasodilators and diuretics were used. According to the diuretics, patients were divided into two groups including a furosemide group(group F) with 38 patients and a lyophilized recombinant human brain natriuretic peptide (lrhBNP) group with 7 patients(group B). Results Preoperatively, 30 patients were pulmonary congestion, which was diagnosed by chest radiographs. Pericardiectomy was finished by off pump in 43 patients. Another 2 patients required cardiopulmonary bypass (CPB) for pericardiectomy. In the group F 52.6% of the patients needed vasodilators to reduce cardiac preloading following pericardiectomy. None of other vasodilators were used in the group B. After pericardiectomy, the fluctuation of systolic and diastolic pressure decreased significantly in the group B (P=0.01, respectively). In the group F, the fluctuation of diastolic pressure decreased significantly (P＜0.05). Low cardiac output was the most common postoperative problem. One patient accepted postoperative extracorporeal membrane oxygenation (ECMO) support. Postoperative poor renal function was found in 42.2% of the patients. Three of them needed hemofiltration. Postoperative poor renal function accompanied by poor hepatic function was found in 15.6% of the patients. One of them used dialysis and artificial liver. Three patients were respiratory failure with longer mechanical ventilation and tracheotomy. The overall perioperative mortality rate was 6.7% (3 patients). All patients, who died or used with hemofiltration, artificial liver and ECMO were found in the group F. Conclusion More stable haemodynamics after pericardiectomy may occur with using lrhBNP. lrhBNP may reduce postoperative major morbidity and mortality. Because of the small group using lrhBNP in our study, more patients using lrhBNP for pericardiectomy need to be studied.
Abstract: Objective To find out the factors which influence plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and assess whether preoperative plasma NT-proBNP levels can predict postoperative outcomes of cardiac surgery. Methods A total of 120 patients including 83 males and 37 females undergoing various cardiac procedures between December 2008 and May 2009 were included in the study. Their age ranged from 25 to 84 years with an average age of 62.13 years. Through pathological diagnosis, 35 patients had heart valve diseases, 74 had coronary artery diseases, 3 had congenital heart diseases and 8 had aortic aneurysm. NT-proBNP, creatinine, cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB) levels were measured preoperatively and 24 hours after operation. Ventilation time, length of stay in ICU or in hospital, and mortality were closely monitored after operation. The following events were regarded as endpoints: (1) ICU stay timegt;4 d; (2) Ventilation timegt;48 h; (3) Death occurred during the first 30 days after operation. Receiver operating characteristic (ROC) curve was used to analyze the prediction function of NTproBNP on endpoint events. Based on the cutoff value, the patients were divided into the NT-proBNP increasing group and nonincreasing group. Univariate and logistic multifactor analysis were adopted to analyze factors which had an influence on preoperative NT-proBNP level. Results NT-proBNP concentration [CM(159mm]increased significantly from 37.5-30 867.0 pg/ml (1 929.12±3 749.44 pg/ml) preoperatively to 177.7-35 000.0pg/ml(2 950.32±4 006.14 pg/ml) 24 hours after operation (t=-2.599, P=0.012). ROC curve demonstrated that a cutoff value above 867 pg/ml preoperatively could predict endpoint events with a sensitivity of 77.8% and a specificity of 62.7%. Ventilation time and length of stay in hospital for the patients in the NT-proBNP increasing group were significantly longer than those of patients in the nonincreasing group (26.44±32.75 h vs. 14.49±9.23 h, t=2.507, P=0.015; 23.70±24.02 d vs. 16.21±8.11 d, t=2.117,P=0.039). Influencing factors on preoperative NTproBNP level included preoperative atrial fibrillation, heart function classification, left ventricular enddiastolic dimension (LVEDD), ejection fraction (EF), pulmonary artery pressure, preoperative creatinine, cTnT and pathological diagnosis. EF (P=0.007) and preoperative atrial fibrillation (P=0.018) were independently associated with preoperative NT-proBNP level. Preoperative NTproBNP was closely related to ventilation time (P=0.015), and length of stay in hospital (P=0.039). Conclusion Preoperative plasma NT-proBNP level presents a high individual variability in patients undergoing cardiac surgery. Ejection fraction and preoperative atrial fibrillation are independently associated with preoperative NT-proBNP level. Preoperative NT-proBNP is a valuable marker in predicting bad outcome in patients undergoing heart surgery.