安定した冠動脈疾患の患者のB型ナトリウレチンペプチドとイシュケミア:ハートとソウル研究からのデータ

Kirsten Bibbins-Domingo¹, Maria Ansari, Nelson B Schiller

¹Department of Medicine, University of California, San Francisco, USA.

Circulation

|December 10, 2003

まとめ

B型ナトリウレチンペプチド (BNP) 濃度の上昇は,安定した冠動脈疾患の患者における心筋不全と関連している. この関連性は,前回の心筋梗塞を患った人ではより強く,BNPテストの制限を説明します.

科学分野:

心臓病学心臓病学
バイオマーカーバイオマーカー
診断検査診断検査

背景:

B型ナトリウレチンペプチド (BNP) の上昇は心不全を示すが,特異性がない.
また,心筋動脈不全はBNPレベルを上昇させ,非症状患者の診断を複雑にする可能性があります.

研究の目的:

BNPレベルと誘導性心筋動脈不全症との関連を調査する.
安定した冠動脈疾患の患者におけるBNPが不血症の信頼できる指標であるかどうかを判断する.

主な方法:

安定した冠動脈疾患を有する外科医の血BNP濃度測定.
ストレスエコーカルディオグラフィによるトレッドミルのテストを行い,誘導性イシュケミアを検出しました.
BNPレベルをクォーティル全体で分析し,混同要因を調整して,イシュケミアと相関しました.

主要な成果:

参加者の32% (113/355) が誘導性イシュケミアを発症しました.
最も高いBNP四分位は,誘導性イシュケミアの2倍のリスクを示しました (aRR 2.0).
関連性は,前回の心筋梗塞 (aRR 2.6) を経験した患者では有意であったが,他の患者では有意ではなかった.

結論:

増加したBNPは,安定した冠動脈疾患における誘導性イシュケミアと独立して関連しています.
この関連性は,前述の心筋梗塞を患った患者において特に顕著である.
静脈機能不全に対するBNPの特異性の欠如は,関連性イシュケミアのせいかもしれない.

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