{"title":"脑利钠肽、心肌壁应激与室性心律失常严重程度的关系。","authors":"Igor Sutovsky, Takao Katoh, Tadaaki Ohno, Hiroshi Honma, Hideo Takayama, Teruo Takano","doi":"10.1536/jhj.45.771","DOIUrl":null,"url":null,"abstract":"<p><p>We previously demonstrated that the severity of arrhythmias is reflected by circulating brain natriuretic peptide (BNP) concentrations in patients without signs of congestive heart failure. In the present study, we evaluated the relationships between the severity of the arrhythmia, BNP concentration, and echocardiographic findings. The subjects consisted of 52 patients with ventricular premature contractions (VPC) but no manifestations of heart failure and no digoxin or beta-blocker therapy. Patients underwent Holter monitoring, plasma sampling for BNP measurement, and transthoracic echocardiography (TTE). We scored the motion of 16 left ventricular segments, deriving a wall-motion score index (WMSI) by totaling the scores and dividing by the number of segments scored. Twenty-three patients with Lown grade I to II arrhythmias constituted group A while group B consisted of 29 Lown III to IV patients. Group B had BNP concentrations triple those in group A (57.2 versus 18.1 pg/mL, P < 0.01). Left ventricular ejection fraction (LVEF) was similar in groups A and B (65.2% versus 62.1%, NS). Although left ventricular end-diastolic dimension (LVEDD) was normal in both groups, group B exhibited a larger LVEDD than group A (50 versus 46 mm, P < 0.005). The correlation (r) between BNP and interventricular septum thickness (IVST) was 0.27 (P = 0.013) in group A and 0.37 (P < 0.0001) in group B. Between BNP and posterior wall thickness (PWT), the correlation was 0.23 (P = 0.014) in group A versus 0.33 (P < 0.0001) in group B. The WMSI in group B was higher than in group A (1.34 versus 1.11, P < 0.05). We believe that besides the changes in echocardiographic parameters, the BNP elevation in group B could be a response to abnormal wall stress from the severe ventricular arrhythmias.</p>","PeriodicalId":14717,"journal":{"name":"Japanese heart journal","volume":"45 5","pages":"771-7"},"PeriodicalIF":0.0000,"publicationDate":"2004-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"18","resultStr":"{\"title\":\"Relationship between brain natriuretic peptide, myocardial wall stress, and ventricular arrhythmia severity.\",\"authors\":\"Igor Sutovsky, Takao Katoh, Tadaaki Ohno, Hiroshi Honma, Hideo Takayama, Teruo Takano\",\"doi\":\"10.1536/jhj.45.771\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>We previously demonstrated that the severity of arrhythmias is reflected by circulating brain natriuretic peptide (BNP) concentrations in patients without signs of congestive heart failure. In the present study, we evaluated the relationships between the severity of the arrhythmia, BNP concentration, and echocardiographic findings. The subjects consisted of 52 patients with ventricular premature contractions (VPC) but no manifestations of heart failure and no digoxin or beta-blocker therapy. Patients underwent Holter monitoring, plasma sampling for BNP measurement, and transthoracic echocardiography (TTE). We scored the motion of 16 left ventricular segments, deriving a wall-motion score index (WMSI) by totaling the scores and dividing by the number of segments scored. Twenty-three patients with Lown grade I to II arrhythmias constituted group A while group B consisted of 29 Lown III to IV patients. Group B had BNP concentrations triple those in group A (57.2 versus 18.1 pg/mL, P < 0.01). Left ventricular ejection fraction (LVEF) was similar in groups A and B (65.2% versus 62.1%, NS). Although left ventricular end-diastolic dimension (LVEDD) was normal in both groups, group B exhibited a larger LVEDD than group A (50 versus 46 mm, P < 0.005). The correlation (r) between BNP and interventricular septum thickness (IVST) was 0.27 (P = 0.013) in group A and 0.37 (P < 0.0001) in group B. Between BNP and posterior wall thickness (PWT), the correlation was 0.23 (P = 0.014) in group A versus 0.33 (P < 0.0001) in group B. The WMSI in group B was higher than in group A (1.34 versus 1.11, P < 0.05). 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引用次数: 18
摘要
我们以前证明,心律失常的严重程度是反映在循环脑钠肽(BNP)浓度的患者没有充血性心力衰竭的迹象。在本研究中,我们评估心律失常的严重程度、BNP浓度和超声心动图结果之间的关系。研究对象包括52例室性早搏(VPC)患者,但没有心衰表现,没有地高辛或受体阻滞剂治疗。患者接受动态心电图监测、血浆BNP测量和经胸超声心动图(TTE)检查。我们对16个左心室节段的运动进行评分,通过将分数相加并除以被评分的节段数得出壁面运动评分指数(wall-motion score index, WMSI)。A组23例为低1 ~ 2级心律失常,B组29例为低3 ~ 4级心律失常。B组BNP浓度为A组的3倍(57.2 vs 18.1 pg/mL, P < 0.01)。A组和B组左室射血分数(LVEF)相似(65.2% vs 62.1%, NS)。两组左室舒张末期尺寸(LVEDD)均正常,但B组左室舒张末期尺寸(LVEDD)大于a组(50 vs 46 mm, P < 0.005)。BNP与室间隔厚度(IVST)的相关性(r) A组为0.27 (P = 0.013), B组为0.37 (P < 0.0001)。BNP与后壁厚度(PWT)的相关性(r) A组为0.23 (P = 0.014), B组为0.33 (P < 0.0001), B组WMSI高于A组(1.34比1.11,P < 0.05)。我们认为,除了超声心动图参数的变化外,B组BNP升高可能是对严重室性心律失常引起的壁应力异常的反应。
Relationship between brain natriuretic peptide, myocardial wall stress, and ventricular arrhythmia severity.
We previously demonstrated that the severity of arrhythmias is reflected by circulating brain natriuretic peptide (BNP) concentrations in patients without signs of congestive heart failure. In the present study, we evaluated the relationships between the severity of the arrhythmia, BNP concentration, and echocardiographic findings. The subjects consisted of 52 patients with ventricular premature contractions (VPC) but no manifestations of heart failure and no digoxin or beta-blocker therapy. Patients underwent Holter monitoring, plasma sampling for BNP measurement, and transthoracic echocardiography (TTE). We scored the motion of 16 left ventricular segments, deriving a wall-motion score index (WMSI) by totaling the scores and dividing by the number of segments scored. Twenty-three patients with Lown grade I to II arrhythmias constituted group A while group B consisted of 29 Lown III to IV patients. Group B had BNP concentrations triple those in group A (57.2 versus 18.1 pg/mL, P < 0.01). Left ventricular ejection fraction (LVEF) was similar in groups A and B (65.2% versus 62.1%, NS). Although left ventricular end-diastolic dimension (LVEDD) was normal in both groups, group B exhibited a larger LVEDD than group A (50 versus 46 mm, P < 0.005). The correlation (r) between BNP and interventricular septum thickness (IVST) was 0.27 (P = 0.013) in group A and 0.37 (P < 0.0001) in group B. Between BNP and posterior wall thickness (PWT), the correlation was 0.23 (P = 0.014) in group A versus 0.33 (P < 0.0001) in group B. The WMSI in group B was higher than in group A (1.34 versus 1.11, P < 0.05). We believe that besides the changes in echocardiographic parameters, the BNP elevation in group B could be a response to abnormal wall stress from the severe ventricular arrhythmias.