2008中西方专家BNP共识观点.ppt

Slide 18 In 325 patients presenting to the ED with dyspnea, BNP levels were determined. Patients were then followed for 6 months looking for the following endpoints: death (cardiac and non-cardiac), hospital admissions (cardiac), and repeat ED visits for CHF. Using Kaplan-Meyer plots for all CHF events, patients who left the emergency department with BNP levels 480 pg/ml had a 6-month cumulative probability of a CHF event of (43%). On the other hand, patients who left the emergency department with BNP levels 230 pg/ml had an excellent prognosis with only 2.5% incidence of CHF end-points. The odds ratio for 6-month CHF death in patients with BNP levels 230 was 46. BNP levels measured in patients presenting with dyspnea to the ED are highly predictive of future cardiac events. Utilization of BNP levels in patients presenting with symptoms of CHF should prove to be a cost-effective way to risk-stratify patients with HF.  From April 2003 through December 2004 there were 48,629 eligible acute HF hospitalization episodes in the ADHERE Registry with documented BNP level and LVEF (LVEF 40%, N = 18,164; LVEF 40%, N = 19,544). BNP levels were 100 in only 3.3% of the total cohort hospitalized with a primary discharge diagnosis of HF. * This graph shows the take home points of the predischarge BNP study. At BNP levels over 700 there is a significant increase in risk of death or readmission. Levels less than 350 confer a significantly lower risk. The hazard ratios are on the right, and the results are statistically significant. These data are from the validation and derivation (whole population). * * 共识声明: BNP策略对门诊患者监控的影响 BNP指导的策略减少心衰相关的住院率和死亡率 使用BNP指导的策略能帮助临床医生优化患者的治疗方案，是否使用β阻滞剂 在CHF中, BNP指导的策略是基于BNP目标值 (100- 300 pg/ml)，而不考虑由于BNP基线水平的异质性所致BNP变化。 这些阈值仅是少量随机研究的结果 BNP指导的策略是安全的，不会导致血液动力学的或肾功能的恶化 ACS中潜在的生化标志物靶标 炎症 斑块破裂 血栓 神经内分泌激活 hs-CRP, Ox LDL MCP-1, MPO, IL18 PAI-1, sCD40L vWF, D dimer BNP, NE 内皮激活 sICAM, pSelectin 心律失常 心肌缺血 坏死 MMP’s, PAPP sCD40L, PIGF cTnT, cTnI, Myo