利用生物标志物患者急性心血管疾病PPT.ppt

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利用生物标志物患者急性心血管疾病PPT.ppt

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利用生物标志物患者急性心血管疾病PPT

CP1189452-27 ED Probability of CHF Recorded P0.0001 from clinical judgment to combined McCullough PA et al: Circulation 106:416, 2002 Diagnostic accuracy (%) Clinicaljudgment BNP Combined 70 72 74 76 78 80 82 74.0 81.2 81.5 n=1,538 BNP Study Primary End Point n=1,586; ?50% CHF; 56% male;64±17 yo; 41% COPD; ?30% Hx CHF CP1189452-28 BNP(pg/mL) Sens Spec PPV NPV 50 97 62 71 95 100 90 76 79 89 150 85 83 83 85 AUC = 0.91 Breathing Not Proper (BNP)Multicenter Trial AJC 95, April 15, 2005 Optimal cut-point Sens Spec PPV NPV Accuracy (%) (%) (%) (%) (%) (%) Rule-in cutpoints All pt (n=599) 900 90 85 76 94 87 50 yr old 450 93 95 67 99 95 n=144 ?50 yr old 900 91 80 77 92 85 n=455 Rule-out pt All pt (n=599) 300 99 68 62 99 83 CP1189452-30 Optimal NT-proBNP Cutpoints for Acute Congestive Heart Failure McCullough PA et al for the BNP Multinational Study Investigators: J Am Coll Cardiol 41:278A, 2003 Application of BNP Testing in CHF “Grey Zone” BNP BNP (pg/mL) “Grey Zone” BNP100-500 pg/mL 26.4% of all cases 16.5%CHF 7.9%No CHF 0 100 200 300 400 500 600 700 800 900 1,000 1,100 1,200 1,300 CP1189452-31 CP1189452-32 pg/mL Coronary pulmonale 200-500 Primary pulmonary 300-500 hypertension Acute pulmonary 150-500 embolism BNP ElevationsRight-Sided Coronary Heart Failure CP1189452-33 Acute or chronic systolic or diastolic HF LV hypertrophy Inflammatory cardiac diseases Systemic arterial hypertension with LVH Pulmonary hypertension Acute or chronic renal failure Ascitic liver cirrhosis Endocrine disorders (eg, hyper-aldosteronism, Cushing’s syndrome) When Can Non-CHF Patients Present with BNP Elevations? CP1189452-34 Well HF patients Acute mitral regurgitation Pulmonary edema 1 hour old Other cases “up-stream” fromleft ventricle Mitral stenosis Atrial myoxma When Will CHF PresentWithout BNP Elevations? P 0.0001 P = 0.9 Baseline BNP Clinical Outcomes P 0.0001 P = 0.9 Death MI N = 1356 N = 320 Morrow DA JACC 2004 CP1173030-6 Relationship of NT-