The Study Of Relationship Between Plasma NT-proBNP And Other Blood Indicators And Cardiac Hemodynamics In The Patients With Acute Coronary Syndrome

Part One The Correlation Analysis between the Detection of Non-invasive Cardiac Hemodynamics and echocardiographyBackground At present,cardiovascular disease has become one of the highest morbidity and mortality disease.The scientific and rational treatment of cardiovascular disease comes from the correct diagnosis.The detection of cardiac function and hemodynamic monitoring is even more important.The current clinical evaluation of cardiac function are the Swan-Ganz catheter and echocardiography.The Swan-Ganz catheter is an invasive inspection,it has a certain risk,the operations require a higher skill level,it does not apply to a long repeated,the scope of application is limited,the cost is high.Echocardiography is an invasive inspection, but It's impacted by different operators and cross-section.People try to find a more convenient,safe and reliable method to instead of the above methods.Impedance cardiogram is one of the application of the body impedance measurement technique in Cardiovascular hemodynamics.The application in clinical is increasing.Objective This study is to understand the possibility of clinical evaluation of cardiac function by non-invasive cardiac hemodynamic detection.Methods In this study we choosed 26 cases of patients of Zhongshan Hospital of Fudan University,11 cases for disease group and 15 cases for healthy group.With informed consent,registered patients' name,gender and age,measured patients' height and weight.For the same cases,after echocardiography we did the non-invasive cardiac hemodynamic detection immediately.The echocardiography used Two-dimensional Simpson method to measure the left ventricular ejection fraction and left ventricular end-diastolic volume values,used Pulse Doppler method to measure the stroke volume,output per minute,left ventricular ejection and left ventricular pre-ejection period values.The non-invasive cardiac hemodynamic detection used CHM T3002 Non-invasive Cardiac Hemodynamic Monitor.Measured the blood pressure of the patients after 10 minutes quiet rest,pasted one-time use cardiac-specific electrode film on the body surface,installed the electrodes and the heart sound transducer,observed the synchronously showed impedance differential map,phonocardiogram and electrocardiogram,freezed the waveform graph,obtained the hemodynamic data of left ventricular ejection fraction(LVEF),stroke volume (SV),cardiac output(CO),stroke index(SVI),cardiac index(CI),pre-ejection phase(PEP),left ventricular ejection period(LVET),PEP/LVET etc..Applied the SPSS 11.5 statistical software for statistical analysis,used linear regression analysis and Bland-Altman consistency analysis for the analysis of the relevance and consistency,p＜0.05 was for the differences with statistical significance.Results In the linear correlation analysis,a significant numerical linear correlation was shown in the LVEF,SV,SVI,EDV,LVET and PEP/LVET indices between the two instruments(p＜0.01),Through the test of significance of the regression coefficient,the above indices had statistical significance(p＜0.01).In the CO and CI, the linear correlation was shown too(p＜0.05),the test of significance of the regression coefficient prompted the statistical significance too(p＜0.05).In PEP,the two instruments measured values was no significant correlation(p＞0.05),the linear regression equations had no significance too.In the Bland-Altman consistency analysis,there were nearly 95%points in the range of consistency limits.In the LVEF and LVET,the largest absolute difference could be clinically accepted,it could be said that in the LVEF and LVET there is a better consistency;In the SV,SVI,CO,CI and EDV,the largest absolute difference were difficult to accepted,So that in the above-mentioned indicators,there were a general consistency of the two methods.In the PEP and PEP/LVET the consistency of the two methods was poor.Conclusion CHM T3002 Non-invasive Cardiac Hemodynamic Monitor is able to reflect the situation of cardiac function in patients,but it can not altemate the evaluation of echocardiography. Part TwoThe Study of Relationship Between Plasma NT-proBNP and Other Blood Indicators and Cardiac Hemodynamics in the Patients with Acute Coronary SyndromeBackground CHD is a human disease which is the first cause of death in today's society.ACS is an important progress in CHD,it is a group of clinical syndrome caused by the acute myocardial ischemia.ACS can divided into STE-AMI, NSTE-AMI and UAP.There is a series of cardiac hemodynamic changes in the patients with ACS.According to the difference of the degrees of myocardial ischemia, it may be varying degrees of decline in ventricular compliance,damage of diastolic function,increasing of peripheral vascular resistance and decline in pump function. BNP is increasing in ACS,and the higher the value is,the greater the probability of the adverse cardiac events occurred will be.Compared with the BNP,NT-proBNP has a longer half-life,higher concentrations of blood and more stability,etc.,so it is more suitable for clinical testing,recently,it's widely used in the diagnosis and differential diagnosis of cardiovascular disease,cTnT has a high degree of specificity in the diagnose of ACS.Once myocardial injury it can be released rapidly in the blood and lasted for a long time,and it is easily measured,so it has a high diagnostic value of the AMI.There is a significant negative correlation between the Peak value of cTnT in patients with ACS and LVEF,cTnT also has a very significant negative correlation with the Killip classification,ventricular end-diastolic volume,left ventricular and systolic volume.CRP is an acute phase protein,and hs CRP is a highly sensitive indicator of infection.The positive rate of CRP in patients with AMI is 92%.With the development of disease,serum levels of CRP is increased gradually.The content of CRP will not only help the diagnosis of AMI,but also can estimate the size of infarct area,especially can judge the condition and prognosis of AMI in the early period.Objective This study was designed to discuss the changes in NT-proBNP,cTnT,hs CRP and other blood parameters and cardiac hemodynamics in the patients with different types of ACS,and the relevance between the Blood parameters and cardiac hemodynamics,to discuss that what can the blood index register in the cardiac hemodynamics in patients with ACS.Method In this study,we choosed 37 cases of patients with ACS from the Cardiac medical intensive care unit of Zhongshan Hospital of Fudan University,male 33 cases and 5 cases of women,age is between 36 and 84-year-old.37 cases of patients with ACS including 5 cases of UAP,6 cases of NSTE-AMI and 26 cases of STE-AMI.The non-invasive cardiac hemodynamic detection use CHM T3002 Non-invasive Cardiac Hemodynamic Monitor,Blood indicators was tested by the laboratory of Zhongshan Hospital of Fudan University.Collected patients' NT-proBNP,cTnT,hs CRP as well as Cr,BUN,UA,TB etc.indicators.Record cardiac pump function(including SV,CO, SVI,CI,LVEF and the largest rate of blood vessel expansion(AMP C)),Systolic function(including PEP,LVET,PEP/LVET,left ventricular function index(Q-Z), electro-mechanical systole(Q-A2),systolic index(IC) and systolic function index (HI)),Diastolic function(including the isovolumic relaxation period(A2-O),the rate of expansion of the largest vessels(AMP O),HA-wave amplitude reduction(AMP A), AMP O/AMP C and AMP A/AMP C),Pre-load(including PCWP,LVEDP and EDV), After the load(including the AC,the TPR and MAP) and for reactive power (including SW,CW,SWI and CWI).Applied the SPSS 11.5 statistical software for statistical analysis,used Kruskal-Wallis rank sum test to analysis the differences in hemodynamic parameters among each group;log-transformed NT-proBNP,cTnT, hsCRP and then do t-test for the differences in blood parameters among each group; the detection of correlation analysis between the blood parameters and non-invasive hemodynamic used Spearman rank correlation test,p＜0.05 was for the differences with statistical significance;the multi-factor correlation analysis of the Blood parameters and hemodynamic parameters used multiple stepwise regression analysis, and the introduction variable was set to the standard of 0.05,the excluding test variable was set to the standard of 0.1.Results The comparison of cardiac hemodynamics:compared with the UAP group, NSTE-ATM group was found a significantly decreased in the EF and LVET,and a significantly increased in the PEP/LVET,PCWP and LVEDP,p＜0.05;STE-ATM group was found a significantly decreased in the EF,LVET,HI,SW and SWI,and a significantly increased in the PEP/LVET,p＜0.05;compared with the NSTE-ATM group,STE-ATM group was found a significantly reduced in the AMP C,IC,HI, PCWP and LVEDP,p＜0.05.The comparison of blood parameters:NT-proBNP in the STE-AMI group was significantly higher than the UAP group,p＜0.05;cTnT in the STE-AMI and NSTE-AMI groups were significantly higher than that in the UAP group,p＜0.01;the remaining differences among the groups was not statistically significant.The relevance of blood parameters and cardiac hemodynamics parameters: NT-proBNP levels was negatively correlated with SV,CO,SVI,CI,EF,AMP C,IC, HI,EDV,AC,SW,CW,SWI and CWI,and it was positively correlated with PEP/LVET and AMP O;cTnT was negative correlation with SV,SVI,AMP C,CO,IC, HI,AMP A,EDV,AC,SW,CW,SWI and CWI;hs CRP levels was negative correlation with SV,CO,SVI,AMP C,HI,EDV,AC,SW,CW,SWI and CWI,and was positively correlated with O/C and AMP O.(p＜0.05)Conclusion NT-proBNP and cTnT levels in the patients with AMI are higher than the patients with UAP;Compared with the patients with UAP,the AMI patients have a lower EF,shorter LVET,larger PEP/LVET,lower HI,SW and SWI.The higher NT-proBNP,cTnT,hs CRP levels reach,the more severe myocardial damage may prompt,the weaker myocardial contractile force may be,the lower the biggest cardiac contractility ejection rate and cardiac output may be,the smaller left ventricular end-diastolic volume may be,less cardiac work may be,and the worse prognosis of patients may be prompted.