CAJ | 학술논문

目的有研究表明,心房颤动(房颤)患者中的血浆B型利钠肽(brain natriuretic peptid,BNP)水平增高.研究为探讨血浆BNP水平对预测环肺静脉消融术(circumferential pulmonary vein ablation,CPVA)后房颤复发的意义.方法69例拟行CPVA治疗的阵发性症状性房颤患者,在 CPVA术前行血浆BNP浓度、经食管超声心动图检查.其中15例食管超声心动图发现心房血栓未行CPVA治疗,54例成功行CPVA治疗.所有患者均无临床心力衰竭症状,所有患者左室射血分数≥50％.平均随访3个月,所有患者随访期间若发作房颤均被要求记录发作持续的时间和次数.所有患者被要求随访期间每月至少做1次24 h Holter,按照是否复发房颤分为:成功组(39例)、失败组(15例).结果59.4％的患者BNP水平超过正常范嗣(0～144 ng/L),但69.6％的患者其BNP水平低于心力衰竭水平(＜500 ng/L).失败组患者BNP水平明显高于成功组(中位数371.6 ng/L与97.4 ng/L,p=0.001).失败组患者的左心房直径明显高于成功组[(53.3±15.1)mm与(45.2±11.2)mm,P=0.036].此外,Spearman's相关分析表明,血浆BNP水平与左心房直径存在明显相关性(r =0.574,P＜0.O1).结论阵发性房颤患者术前血浆BNP水平和左心房直径与射频消融术后房颤复发有相关性,术前BNP水平明显升高、左心房直径明显扩大的患者,CPVA术后复发的可能性高.术前低BNP水平的房颤患者,接受CPVA治疗成功率高,术前检查BNP水平有助于选择适合接受CPVA治疗的患者.
목적 유연구표명,심방전동(방전)환자중적혈장B형리납태(brain natriuretic peptid,BNP)수평증고.연구위탐토혈장BNP수평대예측배폐정맥소융술(circumferential pulmonary vein ablation,CPVA)후방전복발적의의.방법69례의행CPVA치료적진발성증상성방전환자,재 CPVA술전행혈장BNP농도、경식관초성심동도검사.기중15례식관초성심동도발현심방혈전미행CPVA치료,54례성공행CPVA치료.소유환자균무림상심력쇠갈증상,소유환자좌실사혈분수≥50％.평균수방3개월,소유환자수방기간약발작방전균피요구기록발작지속적시간화차수.소유환자피요구수방기간매월지소주1차24 h Holter,안조시부복발방전분위:성공조(39례)、실패조(15례).결과59.4％적환자BNP수평초과정상범사(0～144 ng/L),단69.6％적환자기BNP수평저우심력쇠갈수평(＜500 ng/L).실패조환자BNP수평명현고우성공조(중위수371.6 ng/L여97.4 ng/L,p=0.001).실패조환자적좌심방직경명현고우성공조[(53.3±15.1)mm여(45.2±11.2)mm,P=0.036].차외,Spearman's상관분석표명,혈장BNP수평여좌심방직경존재명현상관성(r =0.574,P＜0.O1).결론진발성방전환자술전혈장BNP수평화좌심방직경여사빈소융술후방전복발유상관성,술전BNP수평명현승고、좌심방직경명현확대적환자,CPVA술후복발적가능성고.술전저BNP수평적방전환자,접수CPVA치료성공솔고,술전검사BNP수평유조우선택괄합접수CPVA치료적환자.
Objective Brain natriuretic peptide(BNP)levels are elevated in patients with atrial fibrillation(AF).The aim of this study is to investigate the relation between the pre-procedural BNP level and the incidence of recurrence AF after circumferential pulmonary vein ablation(CPVA).Methods Plasma BNP level was measured before CPVA in 69 consecutive symptomatic paroxysmal AF(PAF)patients without heart failure symptom.Atrial thrombus was detected by transesophageal echocardiography in 15 patients and CPVA was not performed in these patients.CPVA was successful in the remaining 54 patients and followed up for 3 months.All patients were asked to keep a log of the duration and frequency of their symptoms and underwent 24 h ECG monitoring at least once per month after the ablation.Results At the end of follow up,39 patients were free of AF recurrence(successful group)and 15 patients experienced AF recurrence(failure group).BNP concentration was below the heart failure range(＜ 500 ng/L)in 69.6％patients,but exceeded the normal range(0-144 ng/L)in 59.4％ patients.Median baseline BNP level wassignificantly higher in failure group than in successful group(371.6 ng/L vs.97.4 ng/L,P =0.001).Left atrial(LA)dimension was also larger in failure group than in successful group[(53.3 ± 15.1)mm vs.(45.2 ± 11.2)mm,P =0.036].Moreover,BNP level was positively correlated with LA dimension(r =0.574,P ＜ 0.01).Conclusion The pre-procedural BNP level and LA dimension are predictive of successful CPVA for PAF patients.