Clinical Research Of Plasma Brain Natriuretic Peptide In Congestive Heart Failure

Objective: To evaluate the diagnostic valure of plasma brain natriuretic peptide(BNP), and correlated factor influencing of plasma brain natriuretic peptide in patients with congestive heart failure were analysed. the valure of plasma brain natriuretic peptide in evaluation of prognosis for patients with heart failure was discused. Method: (1)42 dyspnea cases with principle diagnosis of systolic heart failure admitted in 2003 to 2005 was studied, and 22 dyspnea cases with COPD and 22 normal adult as control. LVEF was measured by echocardiography.and the concentration of plasma brain natriuretic peptide was determined by enzyme-linked immunosorbent assay,and the concentration of plasma atrial natriuretic peptide(ANP) was analysed by radioimmunoassay.(2)104 patients with congestive heart failure NYHA II-IV admitted in 2003 to 2005 was studied. LVEF,LVMI, LVESVI, LVEDVI , MR and E/A was measured by echocardiography, and the concentration of plasma BNP was determined by ELISA,and the concentration of plasma ANP was analysed by radioimmunoassay.The Pearson analysis was used to assess possible correlations among BNP and other parameter. (3)100 patients with congestive heart failure NYHA II-IV admitted in 2003 to 2005 was studied. We record the age,the gender,, the etiopathogenisis, the NYHA class , the echocardiography results, the distance of 6-minute walking test, the laboratory results and measured the concentration of BNP, ANP, IL-6, TNF- a respectively. The patients were followed to February 2005 .cardiac death was defined end-point . Kaplan-Meier cumulative survival plot was used to calculate accumulation survival and mortality, and The Cox proportional-hazards regression model was useed to estimate the factors of influence prognosis .Results: (1) In this study.The plasma concentration of BNP in CHF group was significantly highter than in COPD group and normal controls(l559.43 ±743发.52 pmol/m lvs 189.78 ± 123.30 pmol/ml, PO.05; 1559.43 ± 743.52 pmol/ml vs 91.07 + 0.33 pmol/ml,P<0.05).The level of BNP in COPD group was significantly highter than in normal controls( 189.78 +123.30 pmol/ml vs 91.07+50.33 pmol/ml, PO.05); The plasma concentration of ANP in CHF group was significantly highter than in COPD group and normal controls(939.28+555.64 pmol/ml vs 123.07+55.20 pmol/ml, P <0.05; 939.28 + 555.64 pmol/ml vs 117.99+66.30 pmol/ml, P<0.05).The level of ANP in COPD group was highter than in normal controls but it was insignificantThe area under ROC curve for BNP to diagnose CHF was highter than in ANP(93% vs 78%).a cut-off value of 200pg/ml gave sensitivity(93 %)combined with reasonable specialty (91%) for identifying CHF.The corresponding negative predictive value was 93% with a positive predictive value of 91%. (2)Multivariate correlation analysis showed that ,the level of BNP related positively to NYHA classification(r=0.350,P<0.01), related positively to MR(r=0.422, P <0.01) ^ related positively to LVMI(r=0.267, P<0.01)^ related positively to LVESVI(r=0.392, P <0.01),and also related positively to LVEDVI (r=0.396, P<0.01).Level of BNP related negatively to LVEF(r=-0.361,P<0.01).The results of logBNP were same and more significantly. Age* gender, etiopathogenisis, blood presure and E/A was no relativity to Level of BNP.(3)100 subjects enrolled in this study,74 male and 26 female ,mean age 63.4 ± 13.2 years. 15 patients died over a median follow of 288 days, Kaplan-Meier cumulative survival analysis showed that Cumulative Survival was 89.09% at 180 days ,77.77% at 360 days. The univariate Cox analyses displaied that gender LVEF and BNP was predictive factors for mortality,but age > etiopathogenisisN NYHA class x AM\ IL-6> TNF- a -. MR and E/A were no significant difference. The multivariate Cox analyses showed that the independently predictive factors of mortality were BNP (RR 0.834, 95%CI 0.762-0.932), LVEF (RR1.001, 95 % Cl 1.000-1.002).The P -blocker group had a greater dicrease in Plasma concentration of BNP and improving echocardiography results than The no- ￡ -blocker group.Conclusion: (l)BNP,as a new diagnosis index of heart failure,has higher sensitivityx specialty and negative predictive value than ANP.(2)NYHA classification > LVEF^ LVESVI> LVEDVI and MR are major factors influencing the plasma concentration of BNP,but age> gender > etiopathogenisisx blood pressure and E/A have no relativity to levelof BNP.(3)The prognosis of patients with decompensated congestive heart failure is bad, plasma BNP and LVEF are independently risk factors for prognosis. Plasma concentration of BNP can be used as the evaluation of drug effect for CHF.