rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2009-5-5-17-21rpcardio-707Research ArticleORIGINAL STUDIESОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯNEW POSSIBILITIES FOR EVALUATION OF SEVERITY AND PROGNOSIS IN PATIENTS WITH CHRONIC HEART FAILURE BASED ON N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE PLASMA LEVELНОВЫЕ ВОЗМОЖНОСТИ ОЦЕНКИ ТЯЖЕСТИ СОСТОЯНИЯ И ПРОГНОЗА БОЛЬНЫХ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ С ПОМОЩЬЮ N-ТЕРМИНАЛЬНОГО ПРО-МОЗГОВОГО НАТРИЙУРЕТИЧЕСКОГО ПЕПТИДАГалявичА. С.GaljavichA. S.

Республика Татарстан, 420012, Казань, Бутлерова ул., 49

Butlerova ul. 49, Kazan, Republic of Tatarstan, 420012

galyavich@inbox.ruМерясевС. Н.MerjasevS. N.

Республика Татарстан, 423570, Нижнекамск, Ахтубинская ул., 11

Akhtubinskaya ul. 11, Nizhnekamsk, Republic of Tatarstan, 423570

ГалявиР. А.GaljaviR. A.

Республика Татарстан, 420012, Казань, Бутлерова ул., 49

Butlerova ul. 49, Kazan, Republic of Tatarstan, 420012

МерясеваР. Ф.MerjasevaR. F.

Республика Татарстан, 423570, Нижнекамск, Ахтубинская ул., 11

Akhtubinskaya ul. 11, Nizhnekamsk, Republic of Tatarstan, 423570

Казанский государственный медицинский университетРоссияKazan State Medical UniversityRussian FederationНижнекамская центральная районная больницаРоссияNizhnekamsk Central District HospitalRussian Federation200910012016551721Copyright © Galjavich A.S., Merjasev S.N., Galjavi R.A., Merjaseva R.F., 20162016Галявич А.С., Мерясев С.Н., Галяви Р.А., Мерясева Р.Ф.Galjavich A.S., Merjasev S.N., Galjavi R.A., Merjaseva R.F.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/707Aim

Aim. To study an importance of plasma N-terminal pro-brain natriuretic peptide (N-proBNP) in evaluation of severity and prognosis in patients with chronic heart failure (CHF) of ischemic genesis.

Material and methods

Material and methods. 77 patients (60 men and 17 women; 59,4±10,7 y.o.) with CHF of ischemic genesis were included in the study. All patients had sinus rhythm and history of Q wave myocardial infarction. Standard examination was performed to all patients. Besides N-proBNP plasma level and patients yearly survival were evaluated.

Results

Results. N-proBNP plasma level had direct correlation with clinical indices (exercise tolerance, blood pressure, heart rate) and echocardiographic heart sizes. N-proBNP plasma level had relationship with prognosis of CHF patients. Baseline N-proBNP level was more than 2 times higher in died patients in comparison with survived patients. The yearly survival rate of CHF patients was 51,3% if N-proBNP level had been more than 400 fmol/ml (>15% of normal value). The clinico-laboratory index (based on N-proBNP plasma level) of severity and prognosis in CHF patients was developed.

Conclusion

Conclusion. The clinico-laboratory index based on N-proBNP plasma level is easy to use and can improve medical practice.

Цель

Цель. Изучить значение N-терминального про-мозгового натрийуретического пептида (N-проМНП) в оценке тяжести и прогнозе больных хронической сердечной недостаточностью (ХСН) ишемического генеза.

Материал и методы

Материал и методы. В исследование включено 77 больных (60 мужчин и 17 женщин; возраст 59,4±10,7 года) ХСН ишемического генеза с сохранённым синусовым ритмом. Все пациенты перенесли инфаркт миокарда с зубцом Q. Пациентам проведено стандартное клинико-лабораторно-инструментальное обследование. Также определялись уровень N-проМНП в плазме крови и годичная выживаемость больных ХСН.

Результаты

Результаты. Уровень N-проМНП в плазме прямо связан с клиническими показателями (толерантность к физическим нагрузкам, уровень АД, ЧСС), эхокардиографическими размерами сердца и влияет на прогноз больных ХСН. У умерших пациентов с ХСН исходный уровень N-проМНП в плазме увеличен более чем в 2 раза. При увеличении уровня N-проМНП более 400 фмоль/мл (выше 15% от норматива данной лаборатории) годичная выживаемость больных ХСН ишемического генеза составляет 51,3%. Разработан клинико-лабораторный индекс тяжести состояния и прогноза больных ХСН на основе уровня N-проМНП.

Заключение

Заключение. Клинико-лабораторный индекс на основе уровня N-проМНП в плазме является простым в использовании и может найти применение в амбулаторных и в стационарных условиях.

N-терминальный про-мозговой натрийуретический пептидхроническая сердечная недостаточностьвыживаемостьN-terminal pro-brain natriuretic peptidechronic heart failuresurvival rateReferencesGroenning B.A., Nilsson J.C., Sondergaard L. et al. Detection of left ventricular enlargement and impaired systolic function with plasma N-terminal pro brain natriuretic peptide concentrations. Am Heart J 2002;143(5):923-9.Groenning B.A., Nilsson J.C., Sondergaard L. et al. Detection of left ventricular enlargement and impaired systolic function with plasma N-terminal pro brain natriuretic peptide concentrations. Am Heart J 2002;143(5):923-9.Gardner R.S., Ozalp F., Murday A.J. et al. N-terminal pro-brain natriuretic peptide. A new gold standard in predicting mortality in patients with advanced heart failure. Eur Heart J 2003;24(19):1735-43.Gardner R.S., Ozalp F., Murday A.J. et al. N-terminal pro-brain natriuretic peptide. A new gold standard in predicting mortality in patients with advanced heart failure. Eur Heart J 2003;24(19):1735-43.Gustafsson F., Badskjær J., Hansen F.S. et al. Value of N-terminal proBNP in the diagnosis of left ventricular systolic dysfunction in primary care patients referred for echocardiography. Heart Drug 2003;3:141-6.Gustafsson F., Badskjær J., Hansen F.S. et al. Value of N-terminal proBNP in the diagnosis of left ventricular systolic dysfunction in primary care patients referred for echocardiography. Heart Drug 2003;3:141-6.Anand I.S., Fisher L.D., Chiang Y.T. et al. for the Val-HeFT Investigators. Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial (Val-HeFT). Circulation 2003;107(9):1278- 83.Anand I.S., Fisher L.D., Chiang Y.T. et al. for the Val-HeFT Investigators. Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial (Val-HeFT). Circulation 2003;107(9):1278- 83.Kirk V., Bay M., Parner J. et al. N-terminal proBNP and mortality in hospitalised patients with heart failure and preserved vs. reduced systolic function: data from the prospective Copenhagen Hospital Heart Failure Study (CHHF). Eur J Heart Fail 2004;6(3):335-41.Kirk V., Bay M., Parner J. et al. N-terminal proBNP and mortality in hospitalised patients with heart failure and preserved vs. reduced systolic function: data from the prospective Copenhagen Hospital Heart Failure Study (CHHF). Eur J Heart Fail 2004;6(3):335-41.Mancini D., Eisen H., Kussmaul W. et al. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation 1991;83(3):778-86.Mancini D., Eisen H., Kussmaul W. et al. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation 1991;83(3):778-86.Cohn J.N., Levine T.B., Olivari M.T. et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med 1984;311(13):819-23.Cohn J.N., Levine T.B., Olivari M.T. et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med 1984;311(13):819-23.Cohn J.N., Johnson G.R., Shabetai R. et al. Ejection fraction, peak exercise oxygen consumption, cardiothoracic ratio, ventricular arrhythmias, and plasma norepinephrine as determinants of prognosis in heart failure. The V-HeFT VA Cooperative Studies Group. Circulation 1993;87(6 Suppl):VI-5-16.Cohn J.N., Johnson G.R., Shabetai R. et al. Ejection fraction, peak exercise oxygen consumption, cardiothoracic ratio, ventricular arrhythmias, and plasma norepinephrine as determinants of prognosis in heart failure. The V-HeFT VA Cooperative Studies Group. Circulation 1993;87(6 Suppl):VI-5-16.Francis G.S., Goldsmith S.R., Levine T.B. et al. The neurohumoral axis in congestive heart failure. Ann Intern Med 1984;101(3):370-7. 10. Packer M. Neurohumoral interactions and adaptations in congestive heart failure. Circulation 1988;77(4):721-30.Francis G.S., Goldsmith S.R., Levine T.B. et al. The neurohumoral axis in congestive heart failure. Ann Intern Med 1984;101(3):370-7. 10. Packer M. Neurohumoral interactions and adaptations in congestive heart failure. Circulation 1988;77(4):721-30.Remes J., Tikkanen I., Fyhrquist F., Pyörälä K. Neuroendocrine activity in untreated heart failure. Br Heart J 1991;65(5):249-55.Remes J., Tikkanen I., Fyhrquist F., Pyörälä K. Neuroendocrine activity in untreated heart failure. Br Heart J 1991;65(5):249-55.Brooksby P., Batin P., Nolan J. et al. The relationship between QT intervals and mortality in ambulant patients with chronic heart failure. The united kingdom heart failure evaluation and assessment of risk trial (UK-HEART). Eur Heart J 1999;20(18):1335-41.Brooksby P., Batin P., Nolan J. et al. The relationship between QT intervals and mortality in ambulant patients with chronic heart failure. The united kingdom heart failure evaluation and assessment of risk trial (UK-HEART). Eur Heart J 1999;20(18):1335-41.Spargias K.S., Lindsay S.J., Kawar G.I. et al. QT dispersion as a predictor of longterm mortality in patients with acute myocardial infarction and clinical evidence of heart failure. Eur Heart J 1999;20(16):1158-65.Spargias K.S., Lindsay S.J., Kawar G.I. et al. QT dispersion as a predictor of longterm mortality in patients with acute myocardial infarction and clinical evidence of heart failure. Eur Heart J 1999;20(16):1158-65.Mancini D.M., Wong K.L., Simson M.B. Prognostic value of an abnormal signalaveraged electrocardiogram in patients with nonischemic congestive cardiomyopathy. Circulation 1993;87(4):1083-92.Mancini D.M., Wong K.L., Simson M.B. Prognostic value of an abnormal signalaveraged electrocardiogram in patients with nonischemic congestive cardiomyopathy. Circulation 1993;87(4):1083-92.Aaronson K.D., Schwartz J.S., Chen T.M. et al. Development and Prospective Validation of a Clinical Index to Predict Survival in Ambulatory Patients Referred for Cardiac Transplant Evaluation. Circulation 1997;95(12):2660-7.Aaronson K.D., Schwartz J.S., Chen T.M. et al. Development and Prospective Validation of a Clinical Index to Predict Survival in Ambulatory Patients Referred for Cardiac Transplant Evaluation. Circulation 1997;95(12):2660-7.Kearney M.T., Nolan J., Lee A.J. et al. A prognostic index to predict long-term mortality in patients with mild to moderate chronic heart failure stabilized on angiotensin converting enzyme inhibitors. Eur J Heart Fail 2003;5(4):489-97.Kearney M.T., Nolan J., Lee A.J. et al. A prognostic index to predict long-term mortality in patients with mild to moderate chronic heart failure stabilized on angiotensin converting enzyme inhibitors. Eur J Heart Fail 2003;5(4):489-97.

The authors declare that there are no conflicts of interest present.