心房颤动复律对血浆脑利钠肽的影响

血浆脑利钠肽(brain natriuretic peptide,BNP)一直是左心室功能障碍的一个指标[1],其在左心室功能正常的心房颤动(atrial fibrillation,Af)患者中的作用报道不多,且有争论[2~5]。本文前瞻性地研究了左心室功能正常的Af患者复律前后血浆BNP的变化。1资料和方法1.1资料本研究包括了62例左心室功能正常[左心室射血分数(left ventricular ejection fraction,LVEF)≥50%]的Af患者。病因为药物控制良好的轻度高血压、稳定的冠心病或孤立性Af,且在整个研究期间药物不变。除外下述情况:因有症状性低血压、缺血性或充血性心力衰竭需行紧急电复…     

脑钠肽对老年人心房颤动复律和复发的评价作用

目的 通过测定老年人窦性心律（窦律）患者和心房颤动（房颤）患者复律前后的血清脑钠肽（BNP）浓度，探讨其对老年房颤患者的评价作用及在房颤复律前后中的应用价值。方法 选择心功能正常的老年患者102例，其中阵发性房颤28例，持续性房颤40例，窦律34例，采用放射免疫方法测定窦律患者血清BNP浓度，同时对房颤患者进行复律，测定复律前、复律后24h及30d的血清BNP浓度。结果 老年房颤患者的血清BNP浓度显著高于窦律患者，并在复律后显著降低，差异有统计学意义。窦律维持组的血清BNP浓度低于房颤复发组[（238．24±97．45）pg／ml vs（323．24±62．78）pg／ml，P〈0．05]。单因素分析显示年龄、左心房内径、房颤持续时间及BNP浓度与房颤的复发有关，多因素回归分析显示BNP浓度和年龄是复律后房颤复发的独立影响因子。结论 BNP的检测可能对老年人房颤的诊断和评估、预测复律的疗效及房颤的复发具有重要的临床价值。     

Brain natriuretic peptide predicts successful cardioversion in patients with atrial fibrillation and maintenance of sinus rhythm

BACKGROUND: Brain natriuretic peptide (BNP) is released from the heart by hemodynamically induced muscle stretch. Patients with atrial fibrillation have higher levels of BNP than those in sinus rhythm. OBJECTIVE: To assess the usefulness of BNP as a predictor of successful cardioversion in patients with persistent atrial fibrillation and subsequent maintenance of sinus rhythm. SUBJECTS AND METHODS: Twenty patients undergoing cardioversion for persistent atrial fibrillation were enrolled. BNP levels were measured before electric cardioversion, and 30 min and two weeks after cardioversion. Baseline echocardiograms and 12-lead electrocardiograms were obtained from all patients. Patients with valvular disease, previous mitral valve surgery or significant left ventricular dysfunction were excluded. RESULTS: The mean BNP level and the mean heart rate were significantly higher before cardioversion than 30 min after (197+/-132 pg/mL versus 164+/-143 pg/mL, P=0.02, and 77+/-17 beats/min versus 57+/-12 beats/min, P=0.0007, respectively). Patients who reverted back to atrial fibrillation after two weeks had a baseline BNP of 293+/-106 pg/mL, while those who remained in sinus rhythm for two weeks had a lower baseline BNP of 163+/-122 pg/mL (P=0.02). CONCLUSION: In patients with persistent atrial fibrillation, BNP levels are associated with successful cardioversion and maintenance of sinus rhythm two weeks after cardioversion.     

心房颤动患者血浆心房钠尿肽与C型钠尿肽浓度的变化

目的观察心房颤动(简称房颤)患者血浆心房钠尿肽(ANP)和C型钠尿肽(CNP)水平的变化,及其与心脏结构改变的相关性,从而进一步分析ANP、CNP在房颤心房结构重构中的作用。方法入选左心功能正常的房颤患者及无房颤对照组。房颤患者又根据房颤持续时间不同分为阵发性房颤(Paf)组及持续性房颤(Peaf)组。采用酶联免疫吸附法检测血浆ANP和CNP水平,并采用超声心动图测量舒张期左房内径、左室内径、室间隔厚度及左室后壁厚度,并计算左室质量指数。结果入选对照组57例,和房颤组62例(其中Paf组35例,Peaf组27例)。年龄、性别等临床背景资料均无差异,具有可比性。房颤组的血浆ANP和CNP水平明显高于对照组[ANP:(728.1±336.9)pg/ml vs(524.6±165.3)pg/ml,P=0.000;CNP:(114.2±28.6)pg/ml vs(97.1±22.4)pg/ml,P=0.000],且与左房内径明显正相关(ANP:r=0.389,P=0.001;CNP:r=0.344,P=0.004)。此外,ANP与CNP之间呈明显的相关性(r=0.799,P=0.000),CNP与室间隔厚度(r=0.343,P=0.006)、左室后壁厚度(r=0.308,P=0.013)、左室质量指数(r=0.275,P=0.030)相关。结论 ANP和CNP与左房扩大明显相关,可能参与心脏重构的过程。     

Brain natriuretic peptide levels fall rapidly after cardioversion of atrial fibrillation to sinus rhythm

BACKGROUND: Brain natriuretic peptide (BNP) levels have been reported to fall following cardioversion of atrial fibrillation (AF). The mechanism for the fall in BNP has not been elucidated and the potential confounding effects of sedation have not been investigated. Sedation may alter BNP levels via its effects on loading conditions. Accordingly, we studied whether BNP levels change shortly after cardioversion and attempted to control for possible effects of sedation. METHODS: BNP levels were obtained before and after cardioversion in patients with AF and in a control group of patients undergoing intravenous conscious sedation for transesophageal echocardiography. RESULTS: BNP levels dropped (260 +/- 255 vs. 190 +/- 212 pg/ml, p < 0.05) 40 min after cardioversion, decreasing in 33 of 41 subjects who achieved sinus rhythm. By contrast, mean BNP did not fall in subjects in whom cardioversion was not successful. The change in BNP level was not related to the degree of change in heart rate. No control subject experienced a change in cardiac rhythm; BNP levels increased (195 +/- 407 vs. 238 +/- 458 pg/ml, p < 0.05) in 18/22 subjects after sedation. Baseline BNP levels were elevated in subjects with AF, and BNP levels were elevated in parallel with heart failure symptoms. CONCLUSIONS: The rapid fall in BNP after cardioversion (1) may reflect prompt hemodynamic improvement associated with rhythm change and (2) does not appear to be due to the effects of sedation.     

Discordant atrial natriuretic peptide and brain natriuretic peptide levels in lone atrial fibrillation

OBJECTIVES: We sought to characterize natriuretic peptide levels in a cohort of rigorously characterized subjects with lone atrial fibrillation (AF). BACKGROUND: Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are sensitive biomarkers of cardiac contractile dysfunction. Both peptides have been reported to be elevated in cohorts with AF, but previous studies have included subjects with underlying structural heart disease. We studied these hormones in 150 subjects with lone AF. METHODS: Study subjects had electrocardiographic evidence of at least one episode of AF and a structurally normal heart on echocardiography. Subjects were excluded if they had a history of a myocardial infarction, rheumatic heart disease, cardiomyopathy, significant valvular disease, hyperthyroidism, or hypertension that preceded the onset of AF. Control subjects were obtained from a healthy outpatient primary care population. Plasma pro-ANP and N-terminal pro-BNP (nt-pro-BNP) levels were determined using commercially available immunoassays. RESULTS: A total of 150 serial subjects with lone AF were enrolled and studied, the majority during normal sinus rhythm. Median levels of nt-pro-BNP were significantly elevated in subjects with lone AF as compared with control subjects (166 vs. 133 fmol/ml, p=0.0003). There was no significant difference in pro-ANP levels between subjects with lone AF and control subjects (1,730 vs. 1,625 fmol/ml, p=0.90). CONCLUSIONS: Discordant natriuretic peptide levels were observed in this homogeneous population of subjects with lone AF. This biomarker pattern, which is present even in sinus rhythm, may represent an underlying subclinical predisposition to this common arrhythmia.     

瑞舒伐他汀对阵发性心房颤动复律后维持窦性心律及P波离散度的影响

目的 观察瑞舒伐他汀对阵发性心房颤动（PAF）复律后维持窦性心律及P波离散度的影响.方法 选择经静脉注射胺碘酮转复后的PAF患者80例随机分为2组,对照组38例单独口服胺碘酮;治疗组42例在对照组治疗的基础上加用瑞舒伐他汀口服.两组疗程均为12个月.结果 治疗组治疗后各时间段的C-反应蛋白（CRP）水平均显著低于对照组（P均〈0.01）;两组患者治疗2周后复律成功率差异无统计学意义（P〉0.05）,治疗后1、6、12个月治疗组窦性心律维持率均显著高于对照组（P均〈0.05）;治疗组最大P波时限（P（max））、P波离散度（Pd）比治疗前和对照组显著缩短（P均〈0.05）.瑞舒伐他汀的不良反应轻微.结论 瑞舒伐他汀联合胺碘酮用于阵发性心房颤动复律后维持窦性心律效果良好,显著降低CRP水平,显著缩短最大P波时限和P波离散度,安全性好.     

血浆B型利钠肽与心房颤动研究进展

B型利钠肽（BNP）是一种心脏神经激素,其在心脏容量和压力超负荷引起心肌牵张时释放,参与体液平衡的调节。近年来的研究表明血浆BNP水平与心房颤动（AF）存在一定的相关性。该文就AF发作时血浆BNP的变化以及血浆BNP预测AF治疗的预后和预测AF相关的血栓事件进行综述。     

血浆脑钠肽与心房颤动

脑钠肽（brain natriuretic peptide,BNP）是一种心脏神经激素,其在心脏容量和压力超负荷引起心肌牵张时释放,参与体液平衡的调节.近些年来的研究表明BNP在心血管疾病的诊断、治疗及预后判定等方面均有重要的临床价值,尤其对于心力衰竭方面的应用更为广泛.近几年国外研究发现在心房颤动（atrial fibrillation,AF）患者中血浆BNP水平明显升高,表明其参与了AF发生的病理生理机制,至今国内的相关研究较少.本文就BNP与AF之间相关性研究的进展作一综述.     

Determinants of brain natriuretic peptide levels in patients with lone atrial fibrillation.

BACKGROUND: Although brain natriuretic peptide (BNP) is increasingly being used for screening and monitoring of congestive heart failure, its utility in patients with lone atrial fibrillation (AF) is unclear. METHODS AND RESULTS: Plasma BNP levels were measured and comprehensive transthoracic echocardiography was performed in 96 subjects (47: sinus rhythm, 49: AF). Patients with structural heart disease were excluded. Potential determinants of BNP levels were identified by univariate and multivariate analyses. Individuals with AF had higher BNP levels than those with sinus rhythm (150 +/- 114 vs 49 +/- 61 pg/ml, p<0.001) The left atrial (LA) volume index (r=0.63, p<0.001), the pulmonary artery systolic pressure (r=0.45, p=0.006), and the early mitral inflow velocity (E)/mitral annular velocity (E') (r=0.36, p=0.04) were found to be independently correlated with BNP level. The correlations between BNP level and LA volume index (p=0.001) or E/E' (p=0.03) were unaltered when subjects with sinus rhythm were removed from the analysis. CONCLUSIONS: BNP levels significantly correlated with LA volume index and E/E' in patients with lone AF, which indicates that the BNP level may reflect early left ventricular dysfunction and LA enlargement in this patient population.     

心房颤动时脑钠肽来源的探讨

目的：通过对比心功能正常的心房颤动及频发室性早搏患者血浆脑钠肽（BNP）水平的差异,探讨心房颤动时BNP的来源。方法：采用化学发光法分别检测47例孤立性心房颤动（房颤组）、43例频发室性早搏患者（室早组）,以及50例健康体检者（健康对照组）的血浆BNP浓度,并采用超声心动图检测三组的左房、左室舒张末内径、左室射血分数,另外对室早组及房颤组行动态心电图检查。结果：1、房颤组、室早组无沦治疗前,治疗成功与失败24h平均心室率均无显著差异;2、房颤组、室早组血浆BNP水平明显高于健康对照组[132．5（78．2,154．3）pg／ml比118．6（66．5,132．3）pg／ml比36．5（14．6,48．5）,P〈0．05）,房颤组血浆BNP水平又明显高于室早组（P〈0．05）;3、经成功治疗后房颤组、室早组的血浆BNP显著下降,与健康对照组无显著差异（P〉0．05）;4、室早治疗失败组BNP水平显著下降,与健康对照组无显著差异（P〉0．05）,房颤治疗失败组BNP水平显著下降,但仍显著高于健康对照组[-70．5（42．5,90．3）pg／ml比36．5（14．6,48．5）pg／m1]（P〈0．05）;结论：心功能正常的频发室性早搏及心房颤动均伴有血浆BNP水平升高,在心室率无显著差异情况下,心房颤动组的BNP水平显著高于室性早搏组,且房颤治疗失败组的BNP水平不能降至正常水平,推测心房颤动时BNP水平的升高有心房因素的参与,是心房因素与心室因素共同作用的结果。     

起搏术后心房颤动的影响因素及心房颤动与心钠素的关系

目的观察心脏起搏术后发生心房颤动(简称房颤)的影响因素及房颤与血心钠素(ANP)的关系。方法选择安装心脏起搏器的患者103例进行随访,分析房颤与年龄、起搏方式、心律失常类型、左房内径(LAD)、左室射血分数(LVEF)和血ANP的关系。结果①65岁以下患者房颤发生率低于65岁以上组(P<0.05)。②VVI组房颤发生率高于DDD组(P<0.05)。③慢快综合征组房颤发生率较缓慢型病窦综合征和房室传导阻滞组高(P<0.05)。④VVI房颤组术后LAD增大、LVEF下降(P<0.05),VVI房颤组术后与DDD组比较有差异(P<0.05)。⑤VVI房颤组和VVI窦性心律组ANP浓度较DDD组高(P<0.05);各组不同心功能级别(NYHA)之间ANP浓度随着心功能级别的加重而升高。结论长期心脏起搏术后房颤的发生可能与年龄大、VVI起搏、病窦综合征(慢快型)、LAD增大、LVEF降低及ANP浓度升高相关。     

阵发性心房颤动对老年高血压患者血浆脑钠肽水平的影响

目的探讨老年高血压患者中血浆脑钠肽(BNP)水平与阵发性心房颤动(PAF)的关系。方法观察36例有PAF的老年高血压患者(A组)的血浆BNP水平、左房内径(LAD)和左室射血分数(LVEF),与36例无PAF病史的高血压患者(B组)进行比较;并在有PAF的老年高血压患者中,观察了19例患者在窦性心律时和房颤发作期的血浆BNP水平对照,以及5例患者在房颤发作前、中、后的血浆BNP水平对照。结果有PAF病史者血浆BNP水平显著高于无PAF病史者[(69.99±55.18)ng/dl比(32.21±22.80)ng/dl,P<0.01]、LVEF显著低于无PAF病史者[(61.48±8.87)%比(67.66±5.06)%,P<0.05],2组左房内径无差异。此外,19例PAF者房颤发作时的血浆BNP水平显著高于窦性心律时[(132.45±46.68)ng/dl比(62.72±38.40)ng/dl,P<0.01],5例PAF者房颤发作时的血浆BNP水平显著高于房颤发作前及房颤中止后的BNP水平[(143.56±57.68)ng/dl比(79.68±27.08)ng/dl及(143.56±57.68)ng/dl比(95.88±38.39)ng/dl,P均<0.05]。结论PAF发作影响老年高血压患者的BNP释放。窦性心律时血浆BNP水平可能用于预测老年高血压患者PAF的发生。     

Short-term effects of sinus rhythm restoration in patients with lone atrial fibrillation: a hormonal study

It is well known that atrial fibrillation can lead to heart failure, and is attributed to rapid ventricular rate (tachycardia-induced cardiomyopathy). Some recent studies suggest the possible existence of an intrinsic left-ventricular factor related to atrial fibrillation, irrespective of other elements. In order to demonstrate the implication of this factor, we measured B-type Natriuretic Peptide, known as a functional marker of left-ventricular dysfunction, in 40 consecutive patients with chronic non-valvular atrial fibrillation, with low ventricular rate and absence of clinical heart failure or echocardiographic left-ventricular dysfunction. In all patients, Brain Natriuretic Peptide (BNP) plasma level was high and dramatically decreased 24 h after external electrical cardioversion (61.4 pg/ml before cardioversion, 23.5 pg/ml 1 day after cardioversion, P<0.002). Our study demonstrates that atrial fibrillation, in absence of high ventricular rate, induces an asymptomatic cardiac alteration that is not detectable by echocardiography.     

脑钠肽心钠肽在心房颤动导管消融术前后的变化

目的:观察脑钠肽(BNP)、心钠肽(ANP)在心房颤动(房颤)导管消融术前、后的变化,探讨其在预测房颤复发的应用价值.方法:连续收集经导管消融术的房颤患者(房颤组)40例,同期连续收集窦性心律患者40例作为对照组,收集房颤组术前、后,对照组入院第2天血清,采用酶联免疫法测定血清BNP浓度.采用放射免疫法测定ANP浓度.结果:房颤组血清BNP浓度显著高于对照组,经过导管消融术后血清BNP、ANP浓度均显著下降,差异有统计学意义,导管消融成功的房颤患者(成功亚组)与对照组BNP浓度无差异,但复发亚组BNP浓度显著高于对照组,差异有统计学意义,术前、后BNP浓度的差值可能与房颤复发有关.结论:BNP对于房颤的诊断与评估及在预测导管消融后房颤复发方面有重要的应用价值.     

Restoration of sinus rhythm with flecainide in patients with atrial fibrillation

The efficacy of flecainide acetate for conversion of atrial fibrillation into sinus rhythm was assessed in 69 patients (mean age of 63 +/- 14 years). Mean duration of the arrhythmia was 49 +/- 45 days. Mean cardiothoracic index was 0.49 +/- 0.03. Flecainide treatment was started intravenously with a bolus of 2 mg/kg over 10 minutes, followed by oral treatment (200 to 300 mg/day) according to body weight. Conversion to sinus rhythm was obtained in 49 patients (71%). The mean delay between initiation of treatment and restoration of sinus rhythm was 301 minutes (range 5 to 1,600). The left atrial diameter was smaller (40 +/- 1 mm) in patients who had successful cardioversion than in those who did not (46 +/- 1 mm) (p less than 0.05). Patients with atrial fibrillation lasting for less than 10 days had a higher conversion rate (79%) than patients with long-standing atrial fibrillation, in whom the conversion rate was only 38% (p less than 0.05). Conversion to sinus rhythm occurred in 33 patients during the first 5 minutes after injection. Adverse effects necessitated discontinuation of treatment in 4 patients (5.8%). Gastrointestinal disorders and dizziness occurred in 5 other patients but did not necessitate discontinuing treatment. In conclusion, flecainide is an effective drug for converting atrial fibrillation into sinus rhythm. Unlike quinidine, flecainide can be administered intravenously. The conversion rate with flecainide is higher in patients with a shorter duration of atrial fibrillation and smaller atria.     

Effect of restoring sinus rhythm on sleep apnea in patients with atrial fibrillation or flutter

Sleep apnea (SA) is more prevalent in patients with atrial fibrillation (AF), but the impact of cardioversion on disordered breathing is unknown. Thus, we investigated the influence of restoring sinus rhythm in patients with AF and atrial flutter (AFlut) on SA. The 16 patients (mean age 63.1 +/- 11.2) with AF (n = 6) or AFlut (n = 10) and SA (apnea-hypopnea index >10) received cardioversion or ablation of cavotricuspid isthmus. We compared the severity of SA by sleep polygraphy under AF/Aflut with the first night after restoring sinus rhythm and after 4 weeks. Apnea-hypopnea index before and immediately after restoring sinus rhythm was similar (31.7 +/- 13.2 vs 30.1 +/- 15.7, p = NS) despite a significantly reduced heart rate (86.7 +/- 26.5 vs 67.8 +/- 11.9 beats/min, p <0.02). After 4 weeks, apnea-hypopnea index remained unchanged (38.1 +/- 18.1, p = NS) although heart rate was further reduced (61.8 +/- 8.8 beats/min, p <0.003). In our study, SA could not be improved by cardioversion of AF/AFlut. Therefore, although it is well known that SA leads to AF, eliminating AF does not cure or improve SA. In conclusion, our study shows that AF should be regarded more as an innocent bystander than a causative or aggravating condition in SA.