Уровень NT-proBNP у амбулаторных пациентов с хронической сердечной недостаточностью и сохраненной фракцией выброса левого желудочка
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Материалы и методы. В исследование включено 96 амбулаторных пациентов с диастолической ХСН I–III функционального класса (ФК) с сохраненной ФВ ЛЖ в возрасте 65,06±1,15 года и 50 практически здоровых людей в возрасте 39,90±1,64 года в качестве контрольной группы, которые прошли профилактический осмотр. Уровень N-терминального фрагмента мозгового натрийуретического пептида (NT-proBNP) в сыворотке крови определяли с использованием тест-системы (Вектор-Бест, Россия).
Результаты. Концентрация NT-proBNP у пациентов с диастолической сердечной недостаточностью с сохранной ФВ ЛЖ составила 108,18±21,64 пг/мл в диапазоне от 0,0 до 1212,3 пг/мл по сравнению с контролем 7,6±1,38 пг/мл, р<0,05. Выявлена положительная корреляционная связь между концентрацией NT-proBNP и площадью левого предсердия (r=0,35), показателями Е/e' ЛЖ (r=0,6), конечно-систолическим объемом ЛЖ (r=0,48). Уровень NT-proBNP не имел корреляционной связи с ФК ХСН (r=0,23) так же, как и со стадией ХСН (r=0,23).
Заключение. Таким образом, пациенты с диастолической ХСН и сохранной ФВ в 67% случаев имели уровень NT-proBNP в крови меньше диагностического порога. Концентрация NT-proBNP в сыворотке крови положительно коррелирует с повышением давления в полости ЛЖ, конечно-систолическим объемом в нем и площадью левого предсердия.
Ключевые слова: диастолическая хроническая сердечная недостаточность, сохранная фракция выброса, NT-proBNP.
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The prevalence of chronic heart failure (CHF) remains high. Echocardiography is a reliable method of diagnosing heart failure. Determination of brain natriuretic peptide allows to identify patients with the most probable diagnosis of heart failure, which requires further instrumental examination of patients.
Aim. To study the level of the brain natriuretic peptide in patients with diastolic chronic heart failure with preserved left ventricular ejection fraction.
Materials and methods. The study included 96 outpatients with diastolic chronic heart failure I–III functional class with a preserved left ventricular ejection fraction at the age of 65.06 ± 1.15 years and 50 practically healthy people aged 39.90 ± 1.64 years as a control group who underwent a preventive examination. The level of the N-terminal fragment of the medullary natriuretic peptide (NT-proBNP) in serum was determined using a test system (Vector-Best, Russia).
Results. The concentration of NT-proBNP in patients with diastolic heart failure with a preserved left ventricular ejection fraction was 108.18 ± 21.64 in the range from 0.0 to 1212.3 pg/ml compared to the control of 7.6 ± 1.38 pg/ml, p<0.05. A positive correlation was found between the concentration of NT-proBNP and the area of the left atrium (r=0.35), left ventricular E/e '(r=0.6), and left ventricular end-systolic volume (r=0.48). The level of NT-proBNP had no correlation with the functional class of CHF (r=0,23), as well as with the stage of CHF (r=0,23).
Conclusions. Thus, patients with diastolic CHF with a preserved ejection fraction in 67% of cases had a level of NT-proBNP in the blood less than the diagnostic threshold. The concentration of NT-proBNP in the serum positively correlates with increased pressure in the cavity of the left ventricle, the end-systolic volume in it and the area of the left atrium.
Keywords: diastolic chronic heart failure, preserved ejection fraction, NT-proBNP.
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17. Hung TC, Wang KT, Yun CH, Kuo JY, Hou CJ, Liu CY, et al. Value of serum N-terminal B-type natriuretic peptide in asymptomatic structural heart disease in Taiwanese population: Comparisons with current ESC Guidelines. Int J Cardiol. 2017;231:195-200. doi:10.1016/j.ijcard.2016.12.180
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1. [Fomin IV. Khronicheskaya serdechnaya nedostatochnost v Rossiyskoy Federatsii: chto segodnya my znayem i chto dolzhny delat. Rossiyskiy kardiologicheskiy zhurnal. 2016;8(136):7-13 (In Russ.)]. doi:10.15829/ 1560-4071-2016-8-7-13
2. Paulus WJ, Tschope C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE, et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J. 2007;28:2539-50. doi:10.1093/eurheartj/ehm037
3. Caballero L, Kou S, Dulgheru R, Gonjilashvili N, Athanassopoulos GD, Barone D, et al. Echocardiographic reference ranges for normal cardiac Doppler data: results from the NORRE Study. Eur Heart J Cardiovasc Imaging. 2015;16:1031-41. doi:10.1093/ehjci/jev083
4. Lang M, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16:233-70. doi: 10.1016/j.echo.2014.10.003
5. Maisel A, Krishnaswamy P, Nowak R, McCord J, Hollander JE, Duc P, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002;347:161-7. doi: 10.1056/NEJMoa020233
6. Mukoyama M, Nakao K, Hosoda K, Suga S, Saito Y, Ogawa Y, et al. Brain natriuretic peptide as a novel cardiac hormone in humans. Evidence for an exquisite dual natriuretic peptide system, atrial natriuretic peptide and brain natriuretic peptide. J Clin Invest. 1991;87:1402-12. doi: 10.1172/JCI115146
7. Hunt PJ, Yandle TG, Nicholls MG Richards AM, Espiner EA. The amino-terminal portion of pro-brain natriuretic peptide (Pro-BNP) circulates in human plasma. Biochem Biophys Res Commun. 1995;214:1175-83. doi: 10.1006/bbrc.1995.2410
8. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart J. 2016;37(27):2129-200. doi: 10.1093/eurheartj/ehw128
9. [Mareev VYu, Fomin IV, Ageev FT, Arutyunov GP, Begrambekova YuL, Belenkov YuN, et al. Clinical guidelines. Chronic heart failure (CHF). Russian Heart Failure. 2017;18(1):3-40 (In Russ.)]. doi: 10.18087/rhfj.2017.1.2346
10. Maisel A, Mueller C, Adams K, Anker SD, Aspromonte N, Cleland JGF, et al. State of the art: using natriuretic peptide levels in clinical practice. Eur J Heart Fail. 2008;10:824-39. doi: 10.1016/j.ejheart.2008.07.014
11. Wilson Tang WH, Girod JP, Lee MJ, Starling RC, Young JB, Van Lente F. Plasma B-Type Natriuretic Peptide Levels in Ambulatory Patients With Established Chronic Symptomatic Systolic. Heart Failure Circulation. 2003;108:2964-6. doi: 10.1161/01.CIR.0000106903. 98196.B6
12. Santosa YP, Tjandrawati A, Noormartany, Erwinanto, Yahya AF, Martanto E, et al. Comparison of Pro B-natriuretic Peptide in Hypertensive Patients with and without Diastolic Dysfunction. Acta Med Indones. 2008;40(1):19-23.
13. Knebel F, Eddicks S, Schimke I, Bierbaum M, Schattke S, Beling M, et al. Myocardial tissue Doppler echocardiography and N-terminal
B-type natriuretic peptide (NT-proBNP) in diastolic and systolic heart failure. Cardiobvasc Ultrasoud. 2008;6:45. doi:10.1186/1476-7120-6-45
14. Maisel A, Koon J, Krishnaswamy P, Kazenegra R, Clopton P, Gardetto N, et al. Utility of B-natriuretic peptide as a rapid, point-of-care test for screening patients undergoing echocardiography to determine left ventricular dysfunction. Am Heart J. 2001;141(3):367-74. doi:10.1067/ mhj.2001.113215
15. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17(12):1321-60. doi:10.1093/ehjci/jew082
16. Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, et al. Clinical utility of doppler echocardiography and tissue doppler imaging in the estimation of left ventricular filling pressures. A comparative simultaneous doppler-catheterization Study. Circulation. 2000;102:1788-94.
17. Hung TC, Wang KT, Yun CH, Kuo JY, Hou CJ, Liu CY, et al. Value of serum N-terminal B-type natriuretic peptide in asymptomatic structural heart disease in Taiwanese population: Comparisons with current ESC Guidelines. Int J Cardiol. 2017;231:195-200. doi:10.1016/j.ijcard.2016.12.180
18. [Podzolkov VI, Tarzimanova AI, Loriya IZ. Changes in the level of natriuretic peptides in patients with atrial fibrillation treated with antiarrhythmic drugs. Ration Pharmacother Cardiol. 2015;11(4):365-70 (In Russ.)].
19. Ellinor PT, Low AF, Patton KK, et al. Discordant atrial natriuretic peptide and brain natriuretic peptide levels in atrial fibrillation. J Am Coll Cardiol. 2005;45:82-6. doi:10.1016/j.jacc.2004.09.045
1 ФГБОУ ВО «Уральский государственный медицинский университет» Минздрава России, Екатеринбург, Россия;
2 ГАУЗ СО «Институт медицинских клеточных технологий», лаборатория антивозрастных технологий, Екатеринбург, Россия;
3 ООО Клиника «Уральская», отделение ранней диагностики и лечения хронической сердечной недостаточности, Екатеринбург, Россия
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V.V. KIRILLOVA 1,2,3, L.A. SOKOLOVA 1,3, V.N. MESHCHANINOV 1,2, V.I. PERSHANOVA 3
1 Ural state medical University, Yekaterinburg, Russia;
2 Institute for medical cell technologies, Yekaterinburg, Russia;
3 Medical Center Ural, Department of the early diagnostic and treatment of chronic heart failure, Yekaterinburg, Russia