The Clinical Value Of Combined Measurement Of Plasma N-termina Pro-brain Natriuretic Peptide And Left Ventricular Ejection Fraction For The Severity And The Predicting Prognosis Of Patients With Chronic Heart Failure

Objective: To study the correlation of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP) concentration and left ventricular ejection fraction (LVEF) for the severityand the late prognosis of patients with chronic heart failure (HF).Methods: According to the New York Heart Association (NYHA) functionalclassification system,118in-patients with chronic heart failure, who were admitted in ourcardiac department in2012, were categorized in four different groups. All patients weremeasured for their level of NT-proBNP、the results of LVEF and LVEDD as well.Simultaneously, all the patients were followed up and investigated for their major adversecardiac events during the hospital admission and the period of6months post-hospitalization.Results: The plasma level of NT-proBNP of patients with different NYHAclassification Ⅰ, Ⅱ, Ⅲ and Ⅳ were (482±268.58) pg/ml,(3581.99±1320.79) pg/ml,(5248.77±3691.24) pg/ml,(15050.45±7736.16) pg/ml respectively. Significant differences(all P＜0.05) were identified between the four groups. The LVEF of patients with variedNYHA classification ofⅠ, Ⅱ, Ⅲ and Ⅳ were (61.10±6.00)%,(53.92±9.62)%,(48.20±12.00)%and (38.97±11.37)%respectively. Significant differences (all P＜0.05) wereidentified between the four groups.According to the study, the patients with worse leftventricular systolic dysfunction in NYHA classification, whose NT-proBNP level andLVEDD was relevantly and significantly increased (NT-proBNP: r=0.696, P＜0.05)(LVEDD:r=0.407, P＜0.05). Conversely, the LVEF had a negative correlation with thecardiac function in NYHA categories (r=－0.595, P＜0.05). Furthermore, between theLVEF and the NT-proBNP were indicated a negative correlation (r=－0.484, P＜0.05). In subgroup studies, it had been shown that patients whose NT-proBNP level over orunder1500pg/ml had24.4%or0.00%incidence corresponding to in terms of MACE.Moreover, there were29.55%and10.81%occurrences in terms of MACE events for thepatients with the LVEF below or over45%respectively. On the other hand, patients,whose NT-proBNP level was above1500pg/ml and LVEF was under45%, had31.71%incidence of MACE events during the hospital admission and followed up period. Therewere statistic significance in terms of NT-proBNP level and LVEF between patients withand without MACE events (P＜0.05). The level of NT-proBNP for patients with MACEwere (11532.33±7158.58) pg/ml contrasted in (5165.85±3445.50) pg/ml for patientswithout MACE, and the LVEF were (42.71±12.79)%for patients with MACE compared(51.59±12.10)%for patients without MACE respectively (P＜0.05).The area under the ROC curve was0.821(95％CI0.737～0.905, P<0.05）forpredicting MACE incidence within6months for the patients with heart failure by theNT-proBNP plasma level. Meanwhile, the cutoff value of the NT-proBNP level was5665pg/ml. The sensitivity and the specificity was85.7%and73.2%respectively. Therewas0.698of the area under the ROC curve for predicting the MACE events for patientswith heart failure during the hospital admission and followed up within6months (95%CI:0.566～0.829, P<0.05）.Conclusion:1. The NT-proBNP level tended to increase with the deterioration in the NYHAclassification.2. The LVEF tended to decrease and LVEDD prone to increase with the deteriorationin the NYHA classification.3. With the gradually declined LVEF, the plasma NT-proBNP level steadly increased.4. NT-proBNP and LVEF are independent risk factors to predict MACE incidence ofthe patients with heart failure within6months.The cutoff value of the NT-proBNP leveland LVEF had high sensitivity in prognosis of MACE of patients with heart failure withina6-months-period. 5. The NT-proBNP level and LVEF were effective and objective to evaluate the heartfunction.The combined measurement of NT-proBNP and LVEF could evaluate the risk andlate prognosis of patients with heart failure.