N-terminal pro-B-type natriuretic peptide as a marker of disease severity in patients with pericardial effusions = N-terminal pro-B-type natriuretic peptide as a marker of disease severity in patients with pericardial effusions

다국어 초록 (Multilingual Abstract)

Background/Aims: N-terminal pro-B-type natriuretic peptide (NT-proBNP) has recently been introduced as a useful marker in diagnosing underlying disease in patients with dyspnea and for determining the prognosis of patients with heart failure. The purpose of this study was to evaluate the value of the NT-proBNP as a marker of disease severity in patients with pericardial effusions. Methods: We enrolled 69 consecutive patients who showed moderate or large pericardial effusion with preserved left ventricular (LV) systolic function; 42 patients finally participated in the study, and 13 (31.0%) of them showed cardiac tamponade. We analyzed the etiologies, the clinical and echocardiographic variables, and the serum NT-proBNP levels in these patients. Results: The mean NT-proBNP level was 751±1002 ng/L (range 5 to 5289), and the median level was 385 ng/L (interquartile range 152 to 844). The NT-proBNP levels were higher in those patients with jugular venous distension (p=0.002), pulsus paradoxus (p=0.016), heart rate ≥100/min (p=0.006), cardiac tamponade (p=0.001), large pericardial effusion (p=0.029), exaggerated respiratory variation of the transmitral inflow (p=0.006), or plethora of the inferior vena cava (p=0.01). The NT-proBNP levels showed significant correlation with heart rate (r=0.517, p<0.001) and the diameter of the inferior vena cava (r=0.329, p=0.03). Conclusions: NT-proBNP may be useful as a marker of disease severity in patients suffering from pericardial effusion, but further prospective studies with more patients will be needed.

참고문헌 (Reference)

1 Zipes DP, "text book of cardiovascular medicine" Elservier Saunders 525-, 2005

2 Mottram PM, "Usefulness of B-type natriuretic peptide in hypertensive patients with exertional dyspnea and normal left ventricular ejection fraction and correlation with new echocardiographic indexes of systolic and diastolic function" 92 : 1434-1438, 2003

3 Tschope C, "The role of NT-proBNP in the diagnostics of isolated diastolic dysfunction: correlation with echocardiographic and invasive measurements" 26 : 2277-2284, 2005

4 Mair J, "The impact of cardiac natriuretic peptide determination on the diagnosis and management of heart failure" 39 : 571-588, 2001

5 Reddy PS, "Spectrum of hemodynamic changes in cardiac tamponade" 66 : 1487-1491, 1990

6 Maisel AS, "Rapid measurement of B type natriuretic peptide in the emergency diagnosis of heart failure" 347 : 161-167, 2002

7 Little WC, "Pericardial disease" 113 : 1622-1632, 2006

8 Vinch CS, "Paradoxical changes in brain natriuretic peptide levels and loading conditions after intravenous conscious sedation" 17 : 1191-1196, 2004

9 Shaver JA, "Noninvasive/invasive correlates of exaggerated ventricular interdependence in cardiac tamponade" 37 (37): 71-76, 2001

10 Levin ER, "Natriuretic peptides" 339 : 321-328, 1998

11 Fernandes F, "NT pro-BNP levels in pericardial diseases and how they are used as complementary evaluation method of diastolic restriction: initial experience: 25 cases" 86 : 175-180, 2006

12 Gardner RS, "N-terminal pro-brain natriuretic peptide: a new gold standard in predicting mortality in patients with advanced heart failure" 24 : 1735-1743, 2003

13 Kragelund C, "N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease" 352 : 666-675, 2005

14 Omland T, "N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes" 106 : 2913-2918, 2002

15 Spodick DH, "Low atrial natriuretic factor levels and absent pulmonary edema in pericardial compression of the heart" 63 : 1271-1272, 1989

16 Himelman RB, "Inferior vena cava plethora with blunted respiratory response: a sensitive echocardiographic sign of cardiac tamponade" 12 : 1470-1477, 1988

17 Min PK, "Incremental value of measuring the time difference between onset of mitral inflow and onset of early diastolic mitral annulus velocity for the evaluation of left ventricular diastolic pressures in patients with normal systolic function and an indeterminate E/E'" 100 : 326-330, 2007

18 Goetze JP, "Increased cardiac BNP expression associated with myocardial ischemia" 17 : 1105-1107, 2003

19 Schrier RW, "Hormones and hemodynamics in heart failure" 341 : 577-585, 1999

20 Hall C, "Essential biochemistry and physiology of (NT-pro) BNP" 6 : 257-260, 2004

21 Liang F, "Endothelin-dependent and -independent components of strain-activated brain natriuretic peptide gene transcription require extracellular signal regulated kinase and p38 mitogen-activated protein kinase" 35 : 188-192, 2000

22 Armstrong WF, "Diastolic collapse of the right ventricle with cardiac tamponade: an echocardiographic study" 65 : 1491-1496, 1982

23 Kronzon I, "Diastolic atrial compression: a sensitive echocardiographic sign of cardiac tamponade" 2 : 770-775, 1983

24 Ommen SR, "Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study" 102 : 1788-1794, 2000

25 Sagrista-Sauleda J, "Clinical clues to the causes of large pericardial effusions" 109 : 95-101, 2000

26 Burstow DJ, "Cardiac tamponade: characteristic Doppler observations" 64 : 312-324, 1989

27 Goldstein JA, "Cardiac tamponade, constrictive pericarditis, and restrictive cardiomyopathy" 29 : 503-567, 2004

28 Grose R, "Cardiac tamponade in dogs with normal coronary arteries: I. effect of changing intravascular volume on hemodynamics and myocardial blood flow" 79 : 531-541, 1984

29 Appleton CP, "Cardiac tamponade and pericardial effusion: respiratory variation in transvalvular flow velocities studied by Doppler echocardiography" 11 : 1020-1030, 1988

30 Martins JB, "Can cardiac tamponade be diagnosed by echocardiography?: experimental studies" 60 : 737-742, 1979

31 Hanford DS, "Brain natriuretic peptide is induced by alpha 1-adrenergic agonists as a primary response gene in cultured rat cardiac myocytes" 269 : 26227-26233, 1994

32 de Lemos JA, "B-type natriuretic peptide in cardiovascular disease" 362 : 316-322, 2003

33 Gottdiener JS, "American Society of Echocardiography recommendations for use of echocardiography in clinical trials" 17 : 1086-1119, 2004

34 Spodick DH, "Acute cardiac tamponade" 349 : 684-690, 2003