N-terminal pro-B-type natriuretic peptide and pulmonary echography are predictors of acute heart failure needing early mechanical ventilation in acute coronary syndrome.

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Coronary artery disease Pub Date : 2024-11-01 Epub Date: 2024-06-03 DOI:10.1097/MCA.0000000000001396

María J Cristo-Ropero, Juan C Garcia-Rubira, Francisco Javier Rivera-Rabanal, Tania Seoane-García, Luis Madrona-Jiménez, Álvaro Izquierdo-Bajo, Begoña Hernández-Meneses, Angel Vilches-Arenas, Rafael Hidalgo-Urbano

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引用次数: 0

Abstract

Aim: The aim of this study was to determine the best clinical predictors of acute heart failure needing mechanical ventilation (MV) in the first 48 h of evolution of patients admitted because of acute coronary syndrome (ACS).

Methods: We analyzed a cohort of patients admitted for ACS between February 2017 and February 2018. A pulmonary ultrasound was performed on admission and was considered positive (PE+) when there were three or more B-lines in two quadrants or more of each hemithorax. It was compared with N-terminal pro-B-type natriuretic peptide (NT-proBNP), peak troponin T-us value GRACE (Global Registry of Acute Coronary Events), CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology and American Heart Association guidelines - Bleeding Score), CACS (Canada Acute Coronary Syndrome risk score), and HAMIOT (Heart Failure after Acute Myocardial Infarction with Optimal Treatment score) scores, shock index, ejection fraction, chest X-ray, and Killip class at admission as predictors of MV in the first 48 h of admission.

Results: A total of 119 patients were included: 54.6% with ST elevation and 45.4% without ST elevation. Twelve patients (10.1%) required MV in the first 48 h of evolution. The sensitivity of PE+ was 100% (73.5-100%), specificity 91.6% (84.6-96.1%), and area under the curve was 0.96 (0.93-0.96). The sensitivity of an NT-proBNP value more than 3647 was 88.9% (51.9-99.7%), specificity 92.1% (84.5-96.8%), and area under the curve was 0.905 (0.793-1). The κ statistic between both predictors was 0.579. All the other scores were significantly worse than PE + .

Conclusion: Lung ultrasound and a high NT-proBNP (3647 ng/L in our series) on admission are the best predictors of acute heart failure needing MV in the first 48 h of ACS. The agreement between both tests was only moderate.

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N末端前B型钠尿肽和肺部回声检查是急性冠状动脉综合征患者出现急性心力衰竭、需要早期机械通气的预测指标。

目的：本研究旨在确定因急性冠状动脉综合征（ACS）入院的患者在最初 48 小时内出现需要机械通气（MV）的急性心力衰竭的最佳临床预测指标：我们分析了2017年2月至2018年2月期间因急性冠状动脉综合征入院的一组患者。入院时进行了肺部超声检查，当每个半胸腔的两个象限或更多象限出现三条或更多 B 线时，即视为阳性（PE+）。它与 N 端前 B 型利钠肽 (NT-proBNP)、肌钙蛋白 T-us 峰值 GRACE（全球急性冠脉事件登记）、CRUSADE（不稳定型心绞痛患者的快速风险分层能否通过早期实施美国心脏病学会和美国心脏协会指南抑制不良后果--出血评分）进行了比较、CACS（加拿大急性冠状动脉综合征风险评分）和 HAMIOT（急性心肌梗死后心力衰竭最佳治疗评分）评分、休克指数、射血分数、胸部 X 光片和入院时的 Killip 分级是入院后 48 小时内 MV 的预测因素。结果：共纳入 119 名患者：54.6%的患者ST段抬高，45.4%的患者无ST段抬高。有 12 名患者（10.1%）需要在入院后 48 小时内进行 MV。PE+的敏感性为100%（73.5%-100%），特异性为91.6%（84.6%-96.1%），曲线下面积为0.96（0.93-0.96）。NT-proBNP 值大于 3647 的敏感性为 88.9%（51.9-99.7%），特异性为 92.1%（84.5-96.8%），曲线下面积为 0.905（0.793-1）。两个预测因子之间的κ统计量为 0.579。结论：肺部超声和入院时的高 NT-proBNP（在我们的系列研究中为 3647 ng/L）是预测急性心肌梗死发生后 48 小时内急性心衰需要 MV 的最佳指标。这两项检查的一致性仅为中等。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Coronary artery disease 医学-外周血管病

CiteScore

2.50

自引率

0.00%

发文量

190

审稿时长

6-12 weeks

期刊介绍： Coronary Artery Disease welcomes reports of original research with a clinical emphasis, including observational studies, clinical trials, translational research, novel imaging, pharmacology and interventional approaches as well as advances in laboratory research that contribute to the understanding of coronary artery disease. Each issue of Coronary Artery Disease is divided into four areas of focus: Original Research articles, Review in Depth articles by leading experts in the field, Editorials and Images in Coronary Artery Disease. The Editorials will comment on selected original research published in each issue of Coronary Artery Disease, as well as highlight controversies in coronary artery disease understanding and management. Submitted artcles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.