초록 close

목적 : B-type natriuretic peptide (BNP)는 심실의 부피 팽창과 압력 부하에 반응하여 분비되는 심장 신경 호르몬이며 그 농도는 좌심실 압력, 호흡곤란의 정도, 신 경호르몬 조절 정도와 상관관계가 있어 연속적인 BNP 농도 측정은 증상이 있는 심부전증 환자의 치료의 지침 이 될 수 있다. 또한 myocardial performance index (MPI)는 수축기와 이완기를 포함한 심장의 전체적인 기 능을 반영하고 울혈성 심부전증 환자에서 증가되어 있 었다는 것이 보고 되었다. 그러나 심부전증 치료 전후의 MPI의 변화와 BNP 수치 변화의 상관관계에 대한 보고 는 없는 형편이다. 따라서 본 연구에서는 심부전증의 치 료 전후의 임상 상태, MPI, BNP 변화 들의 상관관계를 알아보고자 하였다. 방법 : NYHA functional class III 이상의 증상으로 병원에 입원하는 심부전증 환자 30명(평균연령: 64±13 세)을 대상으로 하여 이뇨제를 포함한 심부전증 치료를 하였다. 입원 당시와 2개월 후 외래 진료 시 혈중 BNP 농도를 포함한 생화학적 검사와 경흉부 심초음파 검사 를 이용하여 MPI를 포함한 좌심실 기능 평가와 좌심실 크기 측정을 하였다. 결과 : 심부전증 환자 중 입원 당시 NYHA 분류 III 이상에 해당되는 증상을 보일 때 BNP의 평균 농도는 488.64±519.85 pg/mL였고, 증상이 호전된 후에는 319.56±385.39 pg/mL로 유의하게(p-value : 0.014) 감 소하였으며 MPI도 입원 당시 0.62±0.37에서 0.45±0.26 으로 감소하였다. 또한 BNP의 감소 폭이 작은 환자에서 4개월 이내에 재입원하는 비율이 높았다. 입원 당시 증 상이 있는 심부전증 환자에서 좌심실 수축력이 정상이 더라도 MPI와 BNP 농도는 증가되어 있었으며 임상 증 상 호전 후에는 감소되는 경향을 보였다.


Background : B-type natriuretic peptide (BNP) is a cardiac neurohormone secreted from ventricles as a response to ventricular volume expansion and pressure overload. Myocardial performance index (MPI) reflects cardiac systolic and diastolic function and increase in the patients with congestive heart failure (CHF). The purpose of this study was to evaluate the correlation of clinical status of CHF, BNP level, and MPI. Methods : We followed 30 patients (mean age : 64±13) admitted with symptomatic New York Heart Association (NYHA) class III to IV CHF. Medical treatment was done. Biochemical study including BNP level and evaluation of left ventricular (LV) function including MPI by echocardiography were performed at admission and 2 months later. Results : Mean BNP level increased to 488.64±519.85 pg/mL at admission with symptomatic CHF and significantly decreased to 319.56±385.39 pg/mL (p-value : 0.014) after clinical improvement. Mean MPI tended to decrease from 0.62±0.37 to 0.45±0.26. Readmission rate in 4 months was high in the patients with small decrease in BNP level. At admission, the patients with symptomatic CHF showed increased MPI despite of normal LV systolic function and tendency to decrease in MPI after clinical improvement. Conclusion : Increased BNP level and MPI of patients admitted with symptomatic CHF decreased with clinical improvement. The results suggest that BNP level and MPI might be useful to guide treatment of patients with CHF and changes in BNP level during treatment are predictors of early readmission.(Korean J Med 65:535-542, 2003)


Background : B-type natriuretic peptide (BNP) is a cardiac neurohormone secreted from ventricles as a response to ventricular volume expansion and pressure overload. Myocardial performance index (MPI) reflects cardiac systolic and diastolic function and increase in the patients with congestive heart failure (CHF). The purpose of this study was to evaluate the correlation of clinical status of CHF, BNP level, and MPI. Methods : We followed 30 patients (mean age : 64±13) admitted with symptomatic New York Heart Association (NYHA) class III to IV CHF. Medical treatment was done. Biochemical study including BNP level and evaluation of left ventricular (LV) function including MPI by echocardiography were performed at admission and 2 months later. Results : Mean BNP level increased to 488.64±519.85 pg/mL at admission with symptomatic CHF and significantly decreased to 319.56±385.39 pg/mL (p-value : 0.014) after clinical improvement. Mean MPI tended to decrease from 0.62±0.37 to 0.45±0.26. Readmission rate in 4 months was high in the patients with small decrease in BNP level. At admission, the patients with symptomatic CHF showed increased MPI despite of normal LV systolic function and tendency to decrease in MPI after clinical improvement. Conclusion : Increased BNP level and MPI of patients admitted with symptomatic CHF decreased with clinical improvement. The results suggest that BNP level and MPI might be useful to guide treatment of patients with CHF and changes in BNP level during treatment are predictors of early readmission.(Korean J Med 65:535-542, 2003)