Expression Of Plasma BNP And BNP/Urine Creatinine Levels In Patients With Chronic Heart Failure And Their Prognostic Value

Objective Our aim is to study the associations between Brain natriureticpeptide (BNP)、BNP/Urine creatinine(Ucr) levels and cardiac structure、cardiac function index in patients with heart failure and to explore its role inthe development of heart failure. And to evaluate the clinical prognostic valueof plasma BNP and BNP/Ucr in patients with heart failure, three yearsfollow-up was done by telephone. Methods From October2010to August2011in our hospital take70patients with heart failure as the case group and20healthy people as a control group。The patients based on NYHA grading isdivided into cardiac function I levels group17cases,II levels group15cases,III level group31cases,IV levels group7cases. Levels of BNP andBNP/Ucr were examined after admission in all patients, The parameters asleft ventricle end-diastolic diameter(LVEDD)、 left ventricular systolicdiameter(LVEDS)、left atrial diameter（LAD）、left ventricular fractionalshortening（LVFS）and left ventricle ejection fraction(LVEF) were detectedwith echocardiography. Compare the levels of BNP and BNP/Ucr in eachgroup,observed the BNP and BNP/Ucr changes and mutual relationshipbetween different NYHA classification.three years after discharge,telephonefollow-up was performed to the HF patients to document the adverseevents,such as death or readimission and analyze the relationship betweenBNP and prognosis between groups.Results1) BNP levels which increased with heart function classification expressed an exponential growth trend andthe formula is BNP（ng/L）=13.243×e1.424NYHA（F=36.599, P＜0.05；r2=0.738）;2) BNP was positively correlated with LVEDD, LVEDS, LAD andnegatively correlated with LVEF and LVFS (P <0.05);3) Created the ROCcurves about the relation of heart failure, found that the best value of BNP at>108ng/L has a relatively higher sensitivity and specificity for diagnosis theheart failure;4)The prognosis of Group BNP≤100ng/L was significantly betterthan Group100ng/L <BNP <500ng/L and Group BNP≥500ng/L，GroupBNP≥500ng/L have the worst prognosis;5) Age, cardiac functionclassification, taking medication regularly and BNP levels were independentpredictors of survival of the patients with heart disease (P <0.05);6) BNP/Ucrwas positively correlated with LVEDD、 LVEDS、 LAD and negativelycorrelated with LVEF，but it has no relationship with LVFS。Conclusions1.BNP level increases gradually with the deterioration of heart function,indicating that BNP is associated with the extent of heart failure and also asan sensitive index to evaluating cardiac function.2. The levels of plasma BNPhave a good correlation with LVEDD、LVEDS、LVEF、LVFS and LAD inpatients with heart failure which indicates BNP is a good indicator of leftventricular function and left ventricular remodeling.3.Patients with high levelsof BNP have poor outcome within three years.4.BNP/Ucr have significantdifferences in patients with different Cardiac functions and it increases withthe deterioration of heart function.This maybe indicates that BNP levels maybe less affected by the level of kidney metabolism.