| Objectives:To evaluate the effects of recombinant human brainnatriuretic peptide(rhBNP) on neuroendocrine hormone levels and heartfunction in patients with acute coronary syndrome-heart failure.Methods: From March2012to June2013,76consecutive cases withACS-HF were enrolled in this study. The patients were randomly divided intorhBNP group (n=37) and nitroglycerin group (n=39). After admission, allpatients were given basic treatments, such as ECG monitoring, inspiration ofoxygen, antiplatelet, anticoagulation and lipid-lowering etc. The schedule ofpercutaneous coronary intervention was decided by the onset conditions:①The patients suffering from STEMI within24h of symptom onset whilewithout thrombolysis or failure of thrombolysis will undergo immediate PCI.②Patients suffering from ACS over24h of symptom onset while acquiringpossible success of thrombolysis will undergo elective PCI. In rhBNP group,rhBNP was administered on the basis of conventional therapy with the loadingdose of1.5μg/Kg followed by maintenance dose of0.0075-0.020μg/kg.minfor72hours adjusted by the hemodynamic parameters. While in NIT group,nitroglycerin was administered with the initial speed of5μg/min, then5μg/minincrease at a3-5minutes interval, finally up to10-100μg/min adjusted by thehemodynamic parameters. The systolic blood pressure in the two groups is notless than90mmHg during medication. Record the basic clinical data ofpatients in each group, including gender distribution, age, risk factors ofcoronary heart disease (hypertension, dyslipidemia, diabetes, smoking history),drugs used in clinical settings, Killip classification, baseline laboratory testresults in detail. The levels of plasma NT-proBNP, epinephrine,norepinephrine, renin, angiotensinⅡ and aldosterone were measured before treatment and6hours after withdrawal. LVEDV(left ventricular end diastolicvolume), LVESV(left ventricular end systolic volume)and LVEF (leftventricular ejection fraction)were observed and recorded on echocardiographyafter admission and1month after discharge in all patients. Six-minute walkingdistance was tested respectively during hospitalization and1month aftertreatment. Record the incidence of MACE(major adverse cardiac event)in twogroups within six months after discharge, including cardiac death, recurrentsevere heart failure and malignant arrhythmia. All statistical data were dealtwith SPSS19.0, P <0.05was considered statistically significant.Results: A total of76patients were enrolled,37cases in rhBNP group,39cases in NIT group.①The basic clinical data including gender distribution,mean age, risk factors of coronary heart disease (hypertension, dyslipidemia,diabetes, smoking history), Killip classification, drugs used in clinical settingsand baseline laboratory test results between the two groups had nosignificant differences(P>0.05).②The levels of plasma NT-proBNP weresignificantly decreased compared with those pre-treatment in two groups at6hours after treatment. The level of plasma NT-proBNP in rhBNP group werelower than that in NIT group. The difference was considered as statisticallysignificant (P<0.05).③The levels of plasma epinephrine, norepinephrine,renin, angiotensinⅡ and aldosterone in rhBNP group were significantlyreduced compared with those pre-treatment at6hours after treatment. It wassignificantly lower than that in control group(P<0.05). Those levels haddownward trend in NIT group within6hours after treatment compared withthose pre-treatment, but no statistically significant(P>0.05).④Dopplerechocardiography showed that the LVEDV, LVESV, LVEF had no significantdifferences between the two groups before treatment(P>0.05). Theseindicators in two groups were improved after1month (P<0.05). The LVEDV,LVESV in rhBNP group were lower than those in NIT group(P<0.05), whilethe LVEF in rhBNP group was higher than that in NIT group(P<0.05). Thedifferences were considered as statistically significant.⑤Six-minute walkingdistance in1month after treatment were significantly increased than that during hospitalization(P<0.05), it was more significant in rhBNP group thanthat in NIT group(P<0.05).⑥The rate of MACE within6months betweenthe two groups showed that it was lower in rhBNP group than that in NITgroup (P<0.05).⑦The levels of plasma NT-proBNP and neuroendocrinehormones were significantly decreased compared with those pre-treatment intwo groups. The levels of plasma NT-proBNP and neuroendocrine hormonessuch as epinephrine, norepinephrine renin, angiotensin Ⅱ, aldosterone existedsignificantly positive correlation.Conclusion:1Neuroendocrin system can be activated in patients with acute coronarysyndrome-heart failure during early stage. The levels of plasma NT-proBNPand epinephrine, norepinephrine, renin, angiotensin Ⅱ, aldosterone areincreased in ACS-HF.2Compared with NIT group, the levels of plasma NT-proBNP andepinephrine, norepinephrine, renin, angiotensin Ⅱ, aldosterone weremuchlower in rhBNP group.3rhBNPcan better improve the patient’s cardiac function and long-termprognosis and reduce the incidence of MACE in patients with ACS-HF.4The levels of plasma NT-proBNP and neuroendocrine hormones suchas epinephrine, norepinephrine, renin, angiotensin Ⅱ, aldosterone werepositively correlated significantly. |
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