The Study Of The Relation Between Plasma BNP Levels And LVH,LVDD In Hypertensive Patients

BackgroundAngiocardiopathy and cerebrovascular diseases are common and multi-onset disease,which have serious effects on the health of human beings,and has been be the first cause of death of human beings.Diastolic dysfunction(DD)means that pathophysiologic state which ventricular blood volume decrease or normal but ventricular pressure increase caused by ventricular relaxation or filling dysfunction. Simplex DD can happen in almost all the angiocardiopathy with the symptoms of heart failure or not.The former is called old-age DHF that mainly manifests diastolic dysfunction but the systolic function is normal in all.Recent studies show the focus mainly on the influence of DHF pathogenesis.However,there are investigation show that: in the community only 6%of the patients with moderate diastolic dysfunction can be proved clinical heart failure symptoms,even only 5%of the patients with serious diastolic dysfunction appear heart failure symptoms.In the community,there are a lot of patients with simple diastolic dysfunction but no heart failure symptoms and the ejection fraction is normal.There is scholar call this kind of patients "asymptomatic diastolic dysfunction(ADD)".The ADD mainly manifests in the high risk factors of hypertension, coronary heart disease and diabetes,ect.Because of no clinical symptom,the ADD patients are usually not diagnosed and are not cured that can not draw enough attention of clinical doctors and the patients themselves.Currently,studies are still very limited about crowd morbidity,pathologic physiology characteristics,valid treatment and prognosis relations with old-age DHF.In addition to diastolic dysfunction,the ADD patients, whether systolic function decrease,whether cardiac structure changes.Whether it be the early stage of DHF developing and whether the ADD treatment in subclinical stage can stop or delay the incidence of heart failure or improve the prognosis,there still have no explicit report.Doppler ultrasonic cardiogram is the most extensively used noninvasive testing technique which applied to evaluate diastolic function in clinical currently,but influenced by heart rate,ventricle loading condition and operator's factors such as technique and experience etc.,the clinical application certainly be limited.If can provide a check of accurate blood bio-chemical index sign will be give valid complement to ultrasonic cardiogram to diagnose diastolic dysfunction.Brain natriuretic peptide(BNP) secreted by myocardial cell and Brain natriuretic peptide precursor(NT-prOBNP)have already been proven to go up obviously in systolic Heart Fail(SHF)but there is few report about DHF,especially the consistency of BNP and NT-prOBNP in ADD patients' blood plasma.This research discusses ADD pathologic physiology characteristics by evaluating the changes of ADD patients' diastolic and systolic function and being compare with DHF.In the meantime,the research also discusses the worth of BNP and NT-prOBNP in the diagnosis of ADD and DHF,hoping to go deep into old-age ADD.ObjectivesInquiry the relativity with BNP and Left Ventricular Hypertrophy(LVH)of hypertension sufferers.Inquiry the relativity with BNP and Left Ventricular diastolic dysfunction(LVDD) of hypertension sufferers.Methods1 Datas and methods1.1 general datas:choosing 84 hypertension sufferers in hospital,male 51,female 33;average age(51.3±s 7.8)years old that all according with the diagnosis standards in 2005 Chinese hypertensive prevention and cure guide.Recording their course and degree of hypertension as observing index,with all the indexes of ulterasonic cardiogram as the factors that influence BNP to carry on statisticsing analysis.All sufferers' NYHA heart function≤Ⅰclass,then didn't show obvious heart dysfubradycardia,atrioventricular heart-block,congenital heart disease and valvular heart disease. 1.2 methods(1)Specimen collection:All sufferers who lie quietly were taken out vein blood 3 ml with EDTA to anticoagulate.(2)Use the Triage Meter Plus and original reagents from American Biosite company with immunity fluorescence method to test BNP.The test scope is 5～5000 pgs/ml.Normal value＜100 pg/ml,averrige value 75.2±s 21.6 pg/ml.(datas provided by bio-chemical room in this hospital)(3)Adopting American HP 5500 ultrasound probe head frequency 2.5 MHzs,the Multrasound used to measure interventricular septum thickness(IVST),left ventricle posterior wall thickness(LVPWT)and left ventricular diastolic inner diameter(LVEDD);computing left ventricle weight(LVM)with the Devereux formula,and computing left ventricle weight index(LVMI).Use M type color Doppler to measure flow propagation velocity in early diastolic stage.Use Doppler measures the peak value of flow velocity in the early stage of mitral valve diastolic(E),the peak value in the late stage(A),then calculate E/A.(4) Grouping:According to LVMI,use male＞125 g/m~2,female＞120 g/m~2 as standard,all sufferers are divided into two groups,Left Ventricular Hypertrophy(LVH)group and normal group.According to diagnosis standard of diastolic heart dysfunction:a.E/A＜1, b.FPV＜45 cm/s,divided into diastolic dysfunction group and normal group.1.3 statistical treatment data analysis using SPSS 11.5(x±s),group compared with the t test.Indexes and the observation of the relationship between BNP using correlation analysis.Results2.1 Non-LVH group and LVH group cardiac ultrasound indicators and the concentration of BNP LVH group compared with non-LVH,BNP increased significantly,left ventricular posterior wall thickness indicators which reflecting left ventricular hypertrophy also increased significantly.In addition,the left ventricular diastolic dysfunction indicators E/ A ratio and FPV in LVH group also markedly lower.2.2 the cardiac ultrasound indicators BNP concentration changes of diastolic function in normal group and diastolic dysfunction groupCompared to the diastolic function normal group,the BNP concentration increased significantly in diastolic dysfunction group.But the indicators,left ventricular posterior wall thickness and left ventricular mass index which reflecting left ventricular hypertrophy,in diastolic dysfunction group,there were statistical significant increases.2.3 with age,course of disease and various ultrasound parameters and the relationship between concentration of BNP By age,hypertension duration(years),hypertension grade,and heart ultrasound as a result of various parameters to BNP variables related to variable analysis showed that BNP with the patient's age,hypertension duration,hypertension grade,LVEDD,IVST, LVEF,no obvious correlation,with the LVPWT and LVMI were positively correlated(r =0.74,p＜0.01;r=0.61,p＜0.01);with the E/A ratio and FPV was negatively correlated(r=-0.66,p＜.01;r=-0.65,p＜0.01).Conclusion1.BNP is valuable biochemical indicator to forecast LVH and LVDD in the patients with hypertension but heart function normal.2.There is no obvious correlation between BNP level and LVEDD and LV EF when left ventricular diastolic dysfunction...