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.
Aortic dissection is a life-threatening cardiovascular disease with devastating complications and high mortality. It requires rapid and accurate diagnosis and a focus on prognosis. Many laboratory tests are routinely performed in patients with aortic dissection including D-dimer, brain natriuretic peptide, cardiac troponin I, C-reactive protein, and procalcitonin. D-dimer shows vital performance in the diagnosis of aortic dissection, and brain natriuretic peptide, cardiac troponin I, C-reactive protein, and procalcitonin exhibits important value in risk stratification and prognostic effect in aortic dissection patients. Our review summarized the clinical utility of these laboratory tests in patients with aortic dissection, aiming to provide advanced and comprehensive evidence for clinicians to better understand these laboratory tests and help their clinical practice.
Abstract: Objective To analyze the results of preoperative evaluation of the operability of chronic thromboembolic pulmonary hypertension (CTEPH), and to find parameters to define the inconsistency between the operable lesions of CTEPH and pulmonary vascular resistance (PVR). Methods A total of 133 patients with CTEPH admitted into Anzhen Hospital were enrolled for preoperative assessment of operability from March 2002 to May 2010. There were 86 males and 47 females with an age of 49.10±22.70 years. The patients were divided into operable group (group A, n=82，age of 47.80±21.60 years) and inoperable group (group B, n=51, age of 50.30±23.40 years) according to the assessment suggestion. We evaluated the occluded pulmonary segment（OPS） of all the patients through pulmonary ventilation/perfusion scintigraphy， and measured the plasma aminoterminal Btype natriuretic peptide (NT-pro BNP) and PVR. Then the ratio of NT-pro BNP to OPS and PVR to OPS were calculated. [CM(159mm]Results Out of the 82 patients with CTEPH in group A, 81 were positive in the anesthesia test and were subject to pulmonary thromboendarterectomy(PTE). In the whole cohorts of operated patients, there was one early death due to persistent pulmonary hypertension and right heart failure. The specificity of the anesthesia test was 98.78%. Eighty patients (98.77%) were followed up in this group for a period of 1 to 95 months (42.70±28.40 months). During the followup, there was one late death due to pulmonary artery hypertension crisis. Among the 51 patients with CTEPH in group B, there were 32 patients (62.75%) with surgically inaccessible lesions, 13 patients (25.49%) with surgical accessible CTEPH concomitant with severe diseases, and 6 patients (11.76%) with inconsistency between the surgical accessible lesion and high PVR. The ratio of NT-pro BNP to OPS and PVR to OPS for the 81 positive patients in group A was in the range of 80-150 pg·ml-1/OPS and 50-100 dyn·s·cm-5/OPS, respectively. The ratio of NT-pro BNP to OPS (315.00±83.00 pg·ml-1/OPS vs. 115.60±40.50 pg·ml-1/OPS, P=0.000) and PVR to OPS (190.00±57.00 dyn·s·cm－5/OPS vs. 76.40±26.30 dyn·s·cm-5/OPS, P=0.000) for the 6 patients with incosistency between the surgical accessible lesion and high PVR in group B were significantly higher than that for the 81 positive patients in group A. Conclusion Surgically inaccessible CTEPH lesions, CTEPH concomitant with severe diseases, and inconsistency between surgical accessible lesion and high PVR are the three most frequent reasons for denying PTE procedure. The ratio of NTpro BNP to OPS and PVR to OPS may serve as the parameters to define the inconsistency between the surgical accessible lesion and high PVR. Anesthesia test before the PTE procedure may serve as the last evaluation method for the assessment of the operability of CTEPH.
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.
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.
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.
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.
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.
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.
Objective To study the effect and mechanism of recombinant human brain natriuretic peptide (rh-BNP) in alleviating myocardial ischemia-reperfusion (I/R) injury by regulating mitogen activated protein kinase (MAPK) pathway. Methods A total of 128 adult male Sprague-Dawley (SD) rats with specific pathogen free were selected. The SD rats were divided into groups according to random number table, including, sham operation (Sham) group, I/R group, I/R+rh-BNP group, negative control adenovirus (Ad-NC)+Sham group, Ad-NC+I/R group, Ad-NC+I/R+rh-BNP group, p38 mitogen-activated protein kinase adenovirus (Ad-p38MAPK)+I/R group and Ad-p38MAPK+I/R+rh-BNP group, with 16 SD rats in each group. Myocardial I/R injury model was established by ligation of left anterior descending coronary artery. Before modeling, rh-BNP was injected intraperitoneally or adenovirus was injected into myocardium; 180 minutes after reperfusion, the contents of lactate dehydrogenase (LDH), creatine kinase isoenzyme (CK-MB) in serum, myocardial infarction size, the contents of reactive oxygen species (ROS), tumor necrosis factor-α (TNF-α) and the expression of phosphorylated p38MAPK (p-p38MAPK), phosphorylated JNK (p-JNK) and phosphorylated extracellular regulated protein kinases 1/2 (p-ERK1/2) were detected. Results The contents of LDH, CK-MB, myocardial infarction size, the contents of TNF-α, ROS and the expression of p-p38MAPK and p-JNK in I/R group were higher than those in Sham group, p-ERK1/2 expression level was lower than that in Sham group (P<0.05). The contents of LDH, CK-MB, myocardial infarction size, the contents of TNF-α, ROS and the expression of p-p38MAPK in I/R+rh-BNP group were lower than those in I/R group (P<0.05), the expression of p-JNK and p-ERK1/2 had no significant difference compared with I/R group (P>0.05). The contents of LDH, CK-MB, myocardial infarction size, the contents of TNF-α, ROS and the expression of p-p38MAPK in Ad-p38mapk+I/R+rh-BNP group were higher than those in Ad-NC+I/R-rh-BNP group (P<0.05). Conclusion rh-BNP can alleviate myocardial I/R injury, which is related to inhibiting p38MAPK pathway, reducing inflammation response and oxidative stress response.