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目的:评价血浆脑钠尿肽(BNP)作为永久性心脏起搏器植入术后心力衰竭的衡量指标的临床意义。方法:入选行常规植入永久心脏起搏器的患者52例,年齡18～92(70±11)岁。记录患者的诊疗史和检查,心脏超声及收集血液样本,检测BNP。结果:52例患者中(DDD 12例,VVI 38例,其他2例)有19例测量左室射血分数(LVEF≤40%)和有心力衰竭症状(纽约心力衰竭分级Ⅱ、Ⅲ或Ⅳ级)。在取诊断界点为BNP≥425 pmol/L时,所有心力衰竭的患者中BNP作为筛选工具有着95%的灵敏度和57%的特异度。这在应用DDD型起搏器时为灵敏度71%,特度87%,而在应用VVI型起搏器为灵敏度90%,特异度69%。结论:BNP作为一种监测指标对于心脏起搏器植入患者心力衰竭的评定是适合而且有帮助的。
Objective: To evaluate the clinical significance of plasma brain natriuretic peptide (BNP) as a measure of heart failure after permanent pacemaker implantation. Methods: Fifty-two patients with permanent pacemaker implantation were enrolled, aged from 18 to 92 (70 ± 11) years. Record patient’s medical history and examination, echocardiography and collection of blood samples for the detection of BNP. RESULTS: Of the 52 patients (DDD 12, VVI 38, and other 2), 19 had measurements of left ventricular ejection fraction (LVEF ≤ 40%) and symptoms of heart failure (NYHA class II, III or IV ). BNP as a screening tool had 95% sensitivity and 57% specificity for all patients with heart failure when the diagnostic cutoff point was BNP ≥ 425 pmol / L. This is 71% sensitivity and 87% specificity when using a DDD pacemaker and 90% and 69% specificity when using a VVI pacemaker. Conclusion: BNP as a monitoring indicator is appropriate and helpful for the assessment of heart failure in patients undergoing cardiac pacemaker implantation.