The evaluation value of plasma N-terminal natriuretic peptide levels and change rate for the severity and prognosis of patients with acute heart failure

YANG Yanli; AN Jvhui; XUE Zengming

doi:10.3969/j.issn.1002-7386.2018.07.005

Abstract：Objective To investigate the evaluation value of plasma N-terminal natriuretic peptide levels and change rate for the severity and prognosis of patients with acute heart failure.Methods A total of 160 patients with acute heart failure who were diagnosed and treated in our hospital from December 2015 to December 2016 were enrolled in the study. According to the cardiac function classification (NYHA),these patients were divided into four groups. Immediately after admission,the levels of plasma N-terminal natriuretic peptide (NT-proBNP) and high sensitivity C reactive protein (hs-CRP) and cardiac troponin(cTnI) were detected,moreover,the left ventricular ejection fraction(EF) was measured by ultrasoundcardiogram.In addition the ratio of mitral early diastolic peak velocity of mitral annulus velocity/root ratio(E/Ea) was detected by blood flow and tissue Doppler echocardiography,and the correlation between the plasma BNP and EF,E/Ea was analyzed by Pearson correlation analysis.Moreover the plasma levels of NT-proBNP were detected immediately after admission,at 24h,48h and 72h after hospitalization,and the dynamic change rate of plasma NT-proBNP levels at 24h,48h and 72h was calculated by NT-proBNPd 24h,NT-proBNPd 48h,NT-proBNPd 72h.According to the state of diuretic resistance,these patients were divided into diuretic resistance group and diuretic reaction group.The differences of the immediate plasma natriuretic peptide levels and the 24h plasma NT-proBNP levels were compared between the two groups.The receiver operating characteristic curve (ROC) was used to analyze its predictive value for diuretic resistance in patients. According to the prognosis state of patients within 14 days after hospitalization,these patients were divided into survival group and death group,the changes of plasma NT-proBNP levels on admission at 24h,48h, 72h,96h were observed and compared between two groups.Finally,the prognosis evaluation value of plasma N-terminal natriuretic peptide levels changes within 72h after admission was analyzed by ROC analysis. Results The plasma levels of NT-proBNP,hs-CRP and cTnI were increased gradually in the patients with cardiac function NYHA grade I,II,III and IV,there were significant differences among groups (P<0.05).The plasma NT-proBNP was negatively correlated with EF value (r=-0.783,P<0.05),however,which was positively correlated with the ratio of E/Ea(r=0.851,P<0.05).There were no significant differences in immediate levels of plasma NT-proBNP between diuretic resistant group and diuretic response group (P>0.05). However there was significant difference in change rate of plasma NT-proBNP levels within 24 hour between two groups (P<0.05).The change rate of plasma NT-proBNP levels within 24 hours after admission had a good predictive value for patients with diuretic resistance (AUC=0.806).When the change rate of plasma NT-proBNP levels was 34.5%,the sensitivity was 78.13% and specificity was 81.90%.After admission,the plasma levels of NT-proBNP in death group showed a trend of continuous increase,however, the plasma levels of NT-proBNP were decreased rapidly in survival group.The change rate of plasma NT-proBNP levels on 72h after admission had a better diagnostic value (AUC=0.894).When the change rate of plasma NT-proBNP levele in 72h was 65%,the sensitivity of the diagnosis was 76.47% and the specificity was 87.18%.Conclusion The plasma levels of NT-proBNP are related with the severity of patients with acute heart failure,and the levels can reflect the extent of cardiac systolic and diastolic dysfunction.The change rate of plasma NT-proBNP levels within 24 hours on admission can predict the incidence of diuretic resistance in patients,moreover the change rate of plasma levels of NT-proBNP within 72h after admission has better predictive value for prognosis of patients.