Changes And Relevant Factors Of Plasma B-type Natriuretic Peptide Levels In Patents With Acute Coronary Syndrome

Background: Acute coronary syndrome (ACS) is the main causeof patients admitted hospital and death in coronary heart disease.Thestudies of its pathogenesis,diagnosis and treatment are the hot spot inrecent years. B-type natriuretic peptide (BNP) is a cardiogenic hormonesynthesized and secreted by cardiac ventricle.Clinically, BNP has beenwidely used in the diagnosis and the differential diagnosis of heartfailure,judging the degree and the prognosis and guaiding the treatment ofheart failure.BNP is called the first potential"White Cell Count"of heartfailure.Recently, it is reported that the concentration of BNP is increasedin ACS patients. Myocardiac ischemia,necrosis and imflammation maybethe important causes of BNP increasing except heart failure.Objectives: To investigate the changes and the relevant factors ofplasma BNP levers in patents with ACS.Methods and subjects: Collecting 100(male 57, femal 43)patientswho were admitted to Xiangya second hospital cardiac ward duringSeptember to December in 2006. The mean age was63.58±8.97(50-75)years old. The patients were divided into threegroups:(1)NCHD(non coronary heart disease)group:20 controls withnormal heartfunction without myocardiac ischemia and organic heartdisease;(2)SCHD(stable coronary heart disease)group:40 patients ofstable angina pectoris and old cardiac infarction;(3)ACS(acute coronarysyndrome)group:40 patients of unstable angina pectoris and acutemyocardial infarction.According to left ventricular ejective fraction(LVEF):SCHD and ACS group were divided into subgroupⅠ(LVEF≥50%)and subgroupⅡ(LVEF＜50%).Every subgroup contained 20patients.The concentration of BNP was measured by Triage in the subjects.Results:1. The concentration of BNP in ACS group and in SCHDgroup(509.87±80.84pg/ml and 415.06+±99.48pg/ml)were significantlyhigher than in NCHD group(14.85±2.17pg/ml,both of P＜0.01).Althoughthe concentration of the BNP in ACS group was higher than in SCHDgroup, the difference was not statistically significant (P＞0.05).2. The concentration of BNP in subgroupⅡof ACS group andSCHD group were significantly higher than in subgroupⅠ(797.4±158.77pg/ml vs 32.72±5.59pg/ml and 892.55±104.70pg/ml vs127.18±21.32pg/ml,both of P＜0.01); the concentration of BNP insubgroupⅠandⅡof ACS group and SCHD group were significantlyhigher than in NCHD group(14.85±2.17pg/ml),(both of P＜0.01);the concentration of BNP in subgroupⅠof ACS group wassignificantly higher than in SCHD group(P＜0.01),the concentration ofBNP in subgroupⅡof the ACS group was higher than in the SCHD.3. The level of BNP were positively correlated with white bloodcell count(WBC),creatine kinase(CK),high sensitive C-reactiveprotein(hs-CRP),left atrial diameter of systolic(LA),left ventriculardiameter of diastolic(LVD)and poster left ventricular wall thickness ofdiastolic(LVPWT) (r=0.287,0.210,0.511,0.577,0.679 and 0.217,P＜0.01)and was negatively correlation with LVEF(r=-0.781,P＜0.01) in pearsoncorrelation analysis.4. Both of the hs-CRP and LVEF were independently correlatedwith BNP in multiple linear regression (13=0.222and -0.392 respectively, P=0.040 and 0.004).Conclusions: 1. The concentrations of BNP in ACS patients areincreased,especially in the patients with heart failure.2. The hs-CRP and LVEF are the main relevant factors of BNP.3. The concentration detection of BNP is not only the sensitiveindex evaluating the degrees of heart failure,but also maybe the usefulindex judging the degree of myocardiac inflammation,ischemia andnecrosis.