利用生物標(biāo)志物患者急性心血管疾病-資料下載頁
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【正文】 =144 ?50 yr old 900 91 80 77 92 85 n=455 Ruleout pt All pt (n=599) 300 99 68 62 99 83,CP118945230,Optimal NTproBNP Cutpoints for Acute Congestive Heart Failure,McCullough PA et al for the BNP Multinational Study Investigators: J Am Coll Cardiol 41:278A, 2003,Application of BNP Testing in CHF,“Grey Zone” BNP,BNP (pg/mL),“Grey Zone” BNP 100500 pg/mL,26.4% of all cases,16.5% CHF,7.9% No CHF,0,100,200,300,400,500,600,700,800,900,1,000,1,100,1,200,1,300,CP118945231,CP118945232,pg/mL Coronary pulmonale 200500 Primary pulmonary 300500 hypertension Acute pulmonary 150500 embolism,BNP Elevations RightSided Coronary Heart Failure,CP118945233,Acute or chronic systolic or diastolic HF LV hypertrophy Inflammatory cardiac diseases Systemic arterial hypertension with LVH Pulmonary hypertension Acute or chronic renal failure Ascitic liver cirrhosis Endocrine disorders (eg, hyperaldosteronism, Cushing’s syndrome),When Can NonCHF Patients Present with BNP Elevations?,CP118945234,Well HF patients Acute mitral regurgitation Pulmonary edema 1 hour old Other cases “upstream” from left ventricle Mitral stenosis Atrial myoxma,When Will CHF Present Without BNP Elevations?,P 0.0001,P = 0.9,Baseline BNP amp。 Clinical Outcomes,P 0.0001,P = 0.9,Death,MI,N = 1356,N = 320,Morrow DA JACC 2004,CP11730306,Relationship of NTproBNP and cTnT,*P0.01 vs NTproBNP ≤250 ng/L Circulation 110:3206, 2004,*,*,Death/MI at 6 months,Test for interaction: P=NS,%,BNP neg BNP cut point = 80 pg/mL,CP118945245,CONS,INV,BNP pos (19% BNP pos),n= 681 685 156 164,Morrow DA: JACC, 2004,Baseline BNP: CONS vs INV Strategy,BetaBlocker Therapy and BNP Levels,Luchner A et al: JACC 32:1839, 1998,pg/ mL,pmol/ mL,ANP ? 32%,BNP ? 89%,cGMP ? 18%,n=592,n=80,P0.01,P0.01,P0.01,No bblocker (n=592) bblocker (n=80),CP118945259,Outcomes by Number of Positive Outcomes TACTICSTIMI 18,CP114336010,Circ 109:584, 2004,Death or MI (%),P=NS,Positive markers (no.),P=NS,P=NS,2.9,4.4,6.2,6.5,12.1,13.3,Death or MI by Multimarker Approach,Odds of Positive Marker TACTICSTIMI 18,CP11433607,Circ 109:583, 2004,T18 Tnl T11 Tnl Combined T18 TnT T11 TnT Combined T18 BNP T16 BNP Combined T18 CRP T11 CRP Combined,Male more likely,Female more likely,0 0.5 1 1.5
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