| Background:The clinical manifestations of patients with heart failure（HF）lack specificity.At present,NT-pro BNP becomes the most convenient auxiliary examination for clinical diagnosis of HF.Since atrial fibrillation（AF）and renal insufficiency（RI）can cause increase of NT-pro BNP,the presence of AF and RI may affect the interpretation of NT-pro BNP in the diagnosis of HF.In this study,the objective is to investigate the value of NT-pro BNP in diagnosis of HF in patients with AF combined with or without RI by analyzing the differences of NT-pro BNP among patients with HF,AF&HF,AF&CKD&HF.Method:897 patients who were admitted to the First Affiliated Hospital of Jinan University from June 2014 to April 2019 and were first tested for NT-pro BNP≥125ng/L were continuously retrospectively selected.Based on whether the patient’s ECG suggested AF,the patient’s e GFR,and the patient’s NYHA grading,they were divided into the HF group（42 cases）,the AF group（155 cases）,the AF&HF group（388 cases）,the AF&RI group（32 cases）,and the AF&RI&HF group（280 cases）.The specific threshold value of NT-pro BNP in the diagnosis of HF in AF and AF&RI was obtained using correlation analysis and ROC curve analysis.Result:1.The Spearman correlation analysis between NT-pro BNP,LVEF and LA in the HF group and AF&HF group showed that,under the condition of NYHA II,there was no correlation between NT-pro BNP and LVEF(r II=-0.089,p II=0.161).Under the condition of NYHA III and IV,there was negative correlation between NT-pro BNP and LVEF(r III=-0.209 p III=0.018;r IV=-0.401,p IV=0.003);Under the condition of NYHA II and III,there was no significant correlation between NT-pro BNP and LA(r II=0.08,p II=0.231;r III=-0.003,p III=0.97).Under the condition of NYHA IV,there was negative correlation between NT-pro BNP and LA(r IV=-0.314,p IV=0.022).2.The Spearman correlation analysis between NT-pro BNP and LA sizes in AF group and AF&HF group showed that,under the condition of NYHA I,there was positive correlation between NT-pro BNP and LA（r I=0.286,p I<0.001）,and under the condition of NYHA II and III,there was no significant correlation between NT-pro BNP and LA(r II=0.119,p II=0.071;r III=0.043,p III=0.652).Under the condition of NYHA IV,there was negative correlation between NT-pro BNP and LA(r IV=-0.394,p IV=0.007).3.The ROC curve analysis of NT-pro BNP in AF&RI and AF&RI&HF groups showed that a NT-pro BNP cutoff value of 642.5ng/L has a sensitivity of 0.728 and a specificity of 0.787 for diagnosis of HF in patients with AF.4.The Spearman correlation analysis between NT-pro BNP and e GFR in AF&RI group and AF&RI&HF group showed that,there was all negative correlation between NT-pro BNP and e GFR regardless of whether NYHA was graded(r I=-0.219,p I=0.017;r II=-0.209,p II=0.022;r III=-0.218,p III=0.024;r IV=-0.663,p IV<0.001).5.The ROC curve analysis of NT-pro BNP levels in AF&RI and AF&RI&HF groups showed that,under the condition of AF&CKD 3,a NT-pro BNP cutoff value of674.5ng/L has a sensitivity of 0.81 and a specificity of 0.796 for diagnosis of HF;under the condition of AF&CKD4-5,a NT-pro BNP cutoff value of 5242ng/L has a sensitivity of 0.681 and a specificity of 0.833 for diagnosis of HF.Conclusion:1.Compared to patients with HF but without AF,HF combined with AF does not cause further elevation of NT-pro BNP.2.In patients with AF but without HF,the enlargement of LA is the main reason for the increase of NT-pro BNP.In patients with AF combined with HF,ventricular dysfunction is the main reason for the increase of NT-pro BNP.3.In patients with AF and RI,the lower the e GFR,the higher the NT-pro BNP level.4.The normal upper limit values of NT-pro BNP is 642.5ng/L in patients with AF combined with or without CKD stage 3 and is 5242ng/L in patients with AF combined with CKD stage 4 to 5,which makes the diagnosis of HF more significant. |
PDF Full Text Request