拡張型心筋症における重症度判定および予後予測の指標としてのBNP測定

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We evaluated the effect of carvedilol on plasma brain natriuretic peptide (BNP), peak oxygen consumption (peak V^^. O_2), NYHA functional class, and echocardiographic findings in patients with dilated cardiomiopathy (DCM). We also evaluated the use of BNP levels for determining the prognosis and optimal timing of heart transplantation. In 34 of 41 patients addition of carvedilol (mean dose: 14 mg daily) was successful. Carvedilol significantly improved the NYHA class, the LVDd, and the LVFS measured by echocardiography. The plasma BNP level was correlated with the NYHA class (r=0.62, p<0.001), the LVDd (r=0.63, p<0.01: NYHASII, r=0.47, p=0.03: NYHA>II, respectively), and the peak V^^. O_2 (regression coefficient: r=-4.179, p=0.015). The prognosis of patients with a BNP level >1,000 pg/ml who failed to respond to carvedilol and could not perform the peak V^^. O_2 measurement protocol was poor. (2/7 were transplanted, and 5/7 died of heart failure). Plasma BNP levels provide prognostic and therapeutic information less invasively in DCM patients, and may be useful for deciding on the optimal timing of heart transplantation in patients with end-stage CHF.
東京女子医科大学の論文
2000-12-25