The Lebanese Society of Cardiology Consensus Statement on the Use of Natriuretic Peptides for the Management of Heart Failure

Plasma concentration of Natriuretic Peptide (NP) is a valuable diagnostic tool for heart failure (HF). It can help rule out or confirm a diagnosis of HF based on symptoms, but its use is not clearly defined. NPs should be used in conjunction with physical examination and other diagnostic tests. However, it is important to note that several conditions besides the diagnosis of HF may cause NPs levels to be elevated. Additionally, there are situations when NP concentrations may be below diagnostic thresholds in [1]. This consensus statement aims to provide a straightforward diagnostic flowchart for clinicians in both the emergency department and outpatient settings to aid in diagnosing both acute and chronic HF. The diagnosis of acute HF can be ruled out with a BNP level of 100 pg/mL or NTproBNP level of 300 pg/mL, regardless of the patient’s age. To identify HF, a 3-level cut-off point based on the patient’s age is recommended. Chronic heart failure can be ruled out with a BNP level of 35 pg/mL or NTproBNP level of 125 pg/mL, regardless of thepatient’s age [1].

Brain natriuretic peptide and optimal management of heart failure

Aside from the important role of brain natriuretic peptide (BNP) in diagnosis, and differential diagnosis of heart failure, this biological peptide has proved to be an independent surrogate marker of rehospitalization and death of the fatal disease. Several randomized clinical trials demonstrated that drugs such as beta blocker, angiotensin converting enzyme inhibitor, spiro- nolactone and amiodarone have beneficial effects in decreasing circulating BNP level during the management of chronic heart failure. The optimization of clinical decision-making appeals for a representative surrogate marker for heart failure prognosis. The serial point-of-care assessments of BNP concentration provide a therapeutic goal of clinical multi-therapy and an objective guid- ance for optimal treatment of heart failure. Nevertheless new questions and problems in this area remain to be clarified. On the basis of current research advances, this article gives an overview of BNP peptide and its property and role in the management of heart failure.

Clinical study of recombinant human brain natriuretic peptide in patients with acute myocardial infarction complicating congestive heart failure

Objectives To observe the efficacy and safety of recombinant human brain natriuretic peptide(rh-BNP) on patients with acute myocardial infarction complicating congestive heart failure.Methods 40 patients with acute myocardial infarction complicated by congestive heart failure were randomly divided into control group and treatment group of 20 cases.The control group,15 cases of acute anterior myocardial infarction,5 cases of acute inferior wall myocardial infarction, 15 males and 5 females,aged 55-70 years,mean age 58±12 years;treated 16 cases of acute anterior myocardial infarction,4 cases of acute myocardial infarction,16 males and 4 females,aged 56-70 years,mean age 59±11 years;two groups of age,gender,severity of disease and vascular lesions no significant difference and comparable(P】0.05).Conventional group were given aspirin,clopidogrel, statins,Inotropic,diuretic and vasodilator therapy.In the con- ventional treatment group based on the use of recombinant human brain natriuretic peptide(new bios,Tibet Pharmaceutical Co.,Ltd.Chengdu Nuodikang biopharmaceutical production, usage:1.5μg/Kg intravenous injection(impact), then 0.0075μg-0.01μg/(kg·min)infusion rate).Continuous medication 72 h.The clinical symptoms observed for 3 days in patients before treatment and after treatment,heart rate,blood pressure and left ventricular ejection fraction (LVEF) and tumor necrosis factor(TNF-α),brain natriuretic peptide(BNP) levels were measured.Results In control group,8 cases markedly effect,5 cases effect and 7 cases no effect,the total effective rate was 65%;In treatment group,13 cases markedly effect,6 cases effect and 1 cases no effect,the total effective rate was 95%,compared with two groups P New bios treatment group significantly increased cardiac index(CI) in patients with heart failure and left ventricular ejection fraction(LVEF) than the control group(all P【0.05),further reduce the levels of tumor necrosis (TNF-α) and brain natriuretic peptide(BNP).Conclusions rh-BNP can improve symptoms and heart function,reduced plasma tumor necrosis factor(TNF-α) and BNP levels of acute myocardial infarction patients with congestive heart failure,the treatment safe and reliable.As small sample size observed,larger sample to be accumulated to further evaluate its efficacy and safety.

Effect of thermal therapy using hot water bottles on brain natriuretic peptide in chronic hemodialysis patients

Introduction: The use of repeated thermal therapy for improving the symptoms of chronic heart failure (CHF) has been recently demonstrated. Usually, thermal therapy requires an infrared dry sauna. However, it is difficult for small clinics to acquire such an expensive and extensive system. The author assessed the efficacy of its substitution with hot water bottles. Moreover, there are no prior studies demonstrating the efficacy of thermal therapy in hemodialysis patients with chronic heart failure. Methods: The author evaluated plasma brain natriuretic peptide (BNP) levels in 98 hemodialysis patients in a clinic. A total of nine patients whose BNP levels were more than 500 pg/mL agreed to be enrolled in this study and received thermal therapy using hot water bottles. Results: Plasma BNP levels, a potential marker for CHF, tended to decrease (891 ± 448 pg/mL to 680 ± 339 pg/mL), but the difference was not significant (P = 0.0845). The oral temperature changed from 36.44℃± 0.45℃ to 37.04℃ ± 0.48℃ (+0.597℃, P < 0.0001). No side effects were experienced during the therapy. Moreover, most patients had an improvement in their symptoms and the ability to perform activities of daily living. Conclusion: Thermal therapy using hot water bottles is very safe and tends to reduce plasma BNP levels in hemodialysis patients with CHF.

The role of B-type natriuretic peptide in the diagnosis and treatment of decompensated heart failure

Heart failure (HF) is a common disease associated with increasing age. B-type natriuretic peptide (BNP), is a cardiac neurohormone, and is released as prepro BNP and then enzyrnatically cleaved to the Ntenninal-proBNP (NT-proBNP) and BNP upon ventricular myocyte stretch. Blood measurements of BNP have been used to identify patients with I-IF. The BNP assay is currently used as a diagnostic and prognostic aid in HF. In general, a BNP level below 100 pg/mL excludes acutely decompensated HF and levels ＞ 500 pg/ml indicate decompensation. Recombinant human BNP (hBNP, nesiritide) is an approved intravenous treatment for acute,decompensated -HF. Nesiritide given in supraphysiologic doses causes vasodilation, natriuresis, diuresis, and improved symptoms over the course of a 48-hour infusion. This paper will sort out the literature concerning the use of this peptide both as a diagnostic test and as an intravenous therapy.

Understanding heart failure in the elderly with respect to diastolic dysfunction and role for natriuretic peptides

The current issue of the Journal of Geriatric Cardiology contains an interesting paper by Dr. Yixin Song and colleagues raising important issues in the diagnosis and management of heart failure in elderly patients. Readers of this journal are in all likelihood aware that the epidemic of heart failure is of great impact medically and economically worldwide.

Prognostic Potential of B - type Natriuetic Peptide and Quality of Life in Patients with Chronic Heart Failure

Objectives To study wheth- er change of BNP levels reflect the change of cardiac function and to investigate the short - term prognostic potential of BNP and QOL in patients with CHF. Methods 96 consecutive patients admittedwith CHF between September 2002 and January 2003 were stud- ied , upon entry the study, BNP levels were measured, Patients administered the disease - specificquality of life questionnaire Minnesota living with heart failure questionnaire (LiHFe) within 1 day. BNP levels and administering LiHFe were repeated three months later. Results BNP levels were increased proportional to the severity of cardiac function. Physical domain and total score of LiHFe were significantly correlated to the severity of CHF ( p < 0. 05 ). BNP levels were de- creased in improving group(p =0. 032) . In deteriora- ting group BNP levels increased (P = 0. 043 ) . Kaplan - meier analysis according to BNP level cutoff point 150 ng/1, the life curve of higher BNP level group was significantly lower than the lower group ( p = 0. 001 ) . In univariate logistic regression, NYHA class, BNP, LVEF, LVEDD, heart size, total score of LiHFe, phys- ical domain of LiHFe and the emotional domain of LiH- Fe were all significant prognostic factors of CHF ( p < 0. 05 for all). While in multiple regression, only BNP level( p = 0. 036) and the emotional domain of LiHFe ( p = 0. 025 ) were independent prognostic factors. Conclusions Change of BNP reflects the treatment efficacy of CHF. BNP and QOL are the two major short - time prognostic factors of the chronic heart failure patients.

新活素对老年急性失代偿期心衰患者心功能及BNP水平的影响分析

目的 探讨老年ADHF患者采取新活素治疗的效果。方法 选取2022年3月—2023年3月本院收治的60例老年ADHF患者,经随机分组后采取不同治疗方式,对比两组临床效果、治疗前后心功能、BNP水平以及生活质量。结果 研究组治疗总有效率高于对照组,组间差异有统计学意义(P<0.05)。治疗前两组LVESD、LVEDD、LVEF等数据无显著差异(P>0.05),治疗后两组LVESD、LVEDD均有所降低(P<0.05),LVEF均有所升高(P<0.05),但研究组LVESD、LVEDD降低更明显,LVEF升高更明显,差异有统计学意义(P<0.05)。治疗前两组BNP水平、MLHFQ评分无显著差异(P>0.05);治疗后两组BNP水平、MLHFQ评分均有所降低(P<0.05),但研究组降低更明显,差异有统计学意义(P<0.05)。结论 采取新活素治疗老年ADHF患者,不仅可提升疗效,改善患者心功能、生活质量,还可降低其BNP水平。

NT-proBNP和D-二聚体及CRP检测对急性脑梗死患者的临床意义

目的:氨基末端脑钠肽前体(NT-pro BNP)、D-二聚体、血清C反应蛋白(CRP)的检测对急性脑梗死患者的临床意义。方法:选取2022年1月—12月河池市中医医院脑病科收治的48例确诊为急性脑梗死患者为研究组,选取同一时间在我院体检科进行体检的49名健康人员为参照组。比较两组研究对象的NT-pro BNP、D-二聚体、CRP水平。结果:急性脑梗死患者的NT-pro BNP,D-二聚体,CRP这三项的检测结果明显高于同一时期体检的健康人,差异有统计学意义(P<0.05)。氨基末端脑钠肽前体(NT-pro BNP)在ROC曲线下的面积为0.945,敏感度为0.833,特异度为0.98;D-二聚体在ROC曲线下的面积为0.948,敏感度为0.833,特异度为0.980;CRP在ROC曲线下的面积为0.955,敏感度为0.896,特异度为0.857。结论:氨基末端脑钠肽前体(NT-pro BNP)、D-二聚体、CRP检测对急性脑梗死具有较高的辅助诊断价值,有助于急性脑梗死患者得到及时的诊治。

左室收缩功能正常的心血管病患者血脑钠肽(BNP)升高相关因素的回顾性分析

目的探索左室收缩功能正常的心血管病患者血浆脑钠肽(brain natriuretic peptide,BNP)升高的相关因素及临床意义。方法收集2007年12月至2010年12月本院心内科住院患者共1 112例,所有患者左室射血分数(left ventricular ejection fraction,LVEF)均大于50%,其中626例BNP<80pg/mL,340例80pg/mL≤BNP<400pg/mL,146例BNP≥400pg/mL。比较3组间的临床特点、生化指标及心超参数,采用方差检验、χ2检验、多分类Logistic回归分析BNP升高的因素。结果 3组间的年龄、心率、血尿素氮(blood urea nitrogen,BUN)、血肌酐、血三酰甘油、血总胆固醇、血浆低密度脂蛋白、空腹血糖、左房内径、左室舒张末期内径、左室收缩末期内径、室间隔厚度、左室后壁厚度、LVEF、肺动脉收缩压、纽约心功能分级、糖尿病、房颤、心肌病、瓣膜病、合并肺部疾病等因素的差异有统计学意义。多分类Logistic回归分析发现:左房内径(OR=1.136,95%CI=1.052～1.227,P=0.001),肺动脉收缩压(OR=1.029,95%CI=1.001～1.058,P=0.04),左室舒张末期内径(OR=0.888,95%CI=0.799～0.987,P=0.028),糖尿病(OR=0.202,95%CI=0.068～0.600,P=0.004)是BNP≥80pg/mL的影响因素。左室收缩末期内径(OR=1.239,95%CI=1.010～1.519,P=0.04),室间隔厚度(OR=8.006,95%CI=2.196～29.191,P=0.002),后壁厚度(OR 0.165,95%CI=0.045～0.597,P=0.006),BUN(OR=7.362,95%CI=1.092～1.699,P=0.006)是BNP≥400pg/mL的影响因素。结论左房内径、肺动脉收缩压、左室舒张末期内径、糖尿病是左室收缩功能正常的心血管病患者血浆BNP≥80pg/mL的影响因素。左室收缩末期内径、室间隔厚度、后壁厚度、BUN为左室收缩功能正常的心血管病患者血浆BNP≥400pg/mL的影响因素。

应用CLSI EP15-A2文件评价BNP和NT-proBNP测定的精密度性能

目的评价西门子ADVIA Centaur化学发光免疫系统检测B型利钠肽(BNP)和罗氏Cobas E601检测N末端B型利钠肽原(NT-proBNP)的精密度性能。方法使用美国临床与实验室标准化协会(CLSI)EP15-A2文件,选用5个不同浓度的BNP和NT-proBNP样本,每个样本每天批内重复测定4次,持续5天,计算批内不精密度(批内CV)和总不精密度(总CV),并与厂商声明的不精密度进行比较。结果 BNP浓度为30.6、70.3、452.2、1069.4、1736.8pg/mL时批内CV分别为2.3%、1.7%、1.8%、1.3%、1.1%,总CV分别为3.5%、3.2%、2.7%、2.6%、2.3%,均低于厂家声明的不精密度;NT-proBNP浓度为72.9、123.9、466.8、2123.9、4322.0pg/mL时批内CV分别为2.2%、1.3%、1.9%、1.2%、1.1%,总CV分别为2.9%、1.9%、2.3%、1.8%、1.5%,NT-proBNP浓度为72.9pg/mL时的不精密度虽高于厂商声明的不精密度,但小于经计算得到的验证值,说明与厂家声明的不精密度无差异,其他浓度均低于厂家声明的不精密度。结论化学发光免疫法测定BNP和电化学发光免疫法测定NT-proBNP测定的精密度性能良好,可满足临床要求。应用EP15-A2文件验证厂商声明的不精密度性能操作简便,经济实用。

BNP、MCP-1对不稳定型心绞痛近期预后判断的价值

目的:探讨血浆B型钠尿肽(brain natriuretic peptide,BNP)、单核细胞趋化蛋白-1(monocyte chemoattractant protein-1,MCP-1)水平对不稳定型心绞痛(unstable angina,UA)近期预后判断的价值。方法:按Braunwald标准,85例心功能正常的UA患者分为ⅠB组(25例)、ⅡB组(30例)及ⅢB组(30例),并取20例稳定型心绞痛(SAP)患者作为对照组。入院后24h内抽肘前静脉血,分别行BNP和MCP-1检测。随访30天内主要不良心脏事件(MACE)。结果:UA组BNP及MCP-1均显著高于对照组(P均<0.05);ⅢB组显著高于ⅠB组和ⅡB组(P均<0.05)。冠状动脉3支与2支病变组BNP明显高于单支病变组(P均<0.05);3支病变组MCP-1明显高于2支及单支病变组(P均<0.05)。Logistic回归分析显示BNP和MCP-1是30天MACE的独立预测因素。结论:血浆BNP、MCP-1水平对心功能正常的UA近期不良预后的评估具有重要意义。

血清BNP水平与急性脑梗死亚型关系研究

目的本文总结了血清BNP水平在心源性脑梗死(CE)与非心源性脑梗死(NCE)人群中的差异,并评估了血清BNP水平鉴别梗死类型的临床意义。方法选择2009年4月～2010年2月,武汉大学人民医院神经科收入的急性脑梗死病人144例,其中心源性脑梗死45例,非心源性脑梗死99例。在入院当天晨起空腹测试其血清BNP水平,并在2周后复查血清BNP。结果心源性脑梗死组BNP水平较非心源性脑梗死组高,且差异有显著性。结论血清BNP水平可以作为临床鉴别心源性梗死与非心源性梗死的初步鉴别指标。

前列地尔脂微球载体对老年肺心病并发心力衰竭者血浆BNP、ET-1水平的影响

目的探讨老年慢性肺心病伴心力衰竭时血浆脑钠素(BNP)、内皮素-1(ET-1)水平变化及前列地尔脂微球载体注射液(Lipo-PGE1,商品名:凯时)对其影响。方法老年慢性肺心病伴心力衰竭患者28例,随机分为治疗组(14例)和常规治疗组(14例)。常规治疗组为降肺动脉压、强心、利尿剂、血管扩张剂等药物并加用鼻导管给氧治疗。治疗组在常规内科治疗同时加用Lipo-PGE1注射液治疗,分别观察治疗10～14d后2组患者临床症状、体征、心率(HR)、呼吸频率(RR)、血压、血氧饱和度(SaO2)、肺动脉压(PAP)和左室射血分数(LVEF)以及血浆BNP、ET-1变化。结果与常规治疗组比较,治疗组治疗10～14d后,患者临床症状与体征改善明显,其SaO2和LVEF显著升高(P<0.05),PAP、HR、RR显著下降(P<0.05)。Lipo-PGE1治疗后血浆BNP、ET-1水平随心衰的纠正而显著降低(P<0.01),与LVEF呈显著负相关(P<0.01),与PAP呈显著正相关(P<0.05)。结论 Lipo-PGE1在改善老年慢性肺心病伴心力衰竭患者心功能和降低PAP的同时,也降低患者血浆BNP、ET-1水平,提示Lipo-PGE1可通过多环节对老年慢性肺心病心力衰竭治疗过程发挥作用。

血清CK-MB、MYO、cTnI和血浆NT-proBNP联合检测诊断急性心肌梗死的临床价值

目的研究急性心肌梗死(AMI)患者血清中肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)、肌钙蛋白I(c Tn I)和血浆氨基末端脑钠肽前体(NT-pro BNP)水平的改变及四项指标的联合检测对诊断AMI的临床价值。方法采用化学发光免疫技术测定208例AMI患者及115例非AMI对照者CK-MB、MYO、c Tn I及血浆NT-pro BNP水平。采用SPSS19.0统计学软件进行分析。结果心梗组患者血清中CK-MB、MYO、c Tn I和血浆NT-pro BNP水平均比对照组高,差异均有统计学意义(P<0.05);CK-MB水平与MYO、c Tn I水平呈明显正相关(r=0.537,P=0.226);CK-MB、MYO、c Tn I和NT-pro BNP单项检测时的灵敏度分别为75.00%、84.62%、79.82%和86.06%,特异度分别为81.74%、69.57%、94.78%和84.35%;CK-MB和MYO、CK-MB和c Tn I、MYO和c Tn I两项联检的灵敏度分别为86.06%、82.21%、85.58%,特异度分别为65.22%、77.39%、67.83%;CK-MB、MYO和c Tn I三项联检时的灵敏度为87.50%,特异度为63.48%;CK-MB、MYO、c Tn I和NT-pro BNP四项联检可将灵敏度提高至92.79%,特异度为69.57%。结论血清CK-MB、MYO、c Tn I和血浆NT-pro BNP联合检测有利于AMI的早期诊断,可为临床提供相应诊疗依据,从而降低急性期的死亡率。

血浆BNP对呼吸困难病因鉴别诊断的价值

目的探讨血浆B型利钠肽(BNP)的测定在呼吸困难病因鉴别诊断中的价值。方法对178例因呼吸困难住院的患者,根据基础疾病、血气分析、肺动脉压力、左心室射血分数(LVEF)、左心室舒张功能等资料分成4组。比较各组血浆BNP水平,再于上述4组内按有无左心室舒张功能不全分为a、b两个亚组,比较两个亚组间的血浆BNP水平。结果 LVEF<40%的1组及2组血浆BNP显著高于LVEF≥40%的3组及4组(P<0.05)。以ROC曲线确定血BNP138.5 ng/L,预测左心室收缩功能不全敏感性为97.7%,特异性为77.2%。各组内有舒张功能不全的亚组其BNP水平显著高于无舒张功能不全的亚组(P<0.05)。结论血浆BNP在呼吸困难病因鉴别诊断中有重要价值。根据血浆BNP测定值结合患者基础疾病及心电图、血气、胸片等情况,临床医师可以比较快速的确定呼吸困难的病因,为抢救、治疗赢得宝贵的时间。

化学发光免疫法检测BNP的分析测量范围和临床可报告范围研究

目的 研究化学发光免疫法检测B型钠尿肽（BNP）的分析测量范围（AMR）和临床可报告范围（CRR）.方法 参照美国临床和实验室标准化研究院（CLSI）发布的EP6-A文件要求制备实验样品,每个样品在西门子ADVIA Centaur化学发光免疫分析系统上重复测定2次,利用多项式回归法确定BNP的分析测量范围;通过稀释回收试验确定最大稀释度,结合功能灵敏度和分析测量范围上限确定临床可报告范围.结果 ADVIA Centaur化学发光免疫分析系统的分析测量范围为2.0～5 094 pg/ml,临床可报告范围为2.5～10 188 pg/ml.结论 厂商声明的ADVIA Centaur化学发光免疫系统检测BNP的分析测量范围得到验证确认,但对于超过分析测量范围的高值标本建议用生理盐水做1∶2稀释.

西安地区血浆BNP正常值的建立及在不同疾病中诊断截断点的研究

目的建立西安地区健康人群血浆脑钠肽（BNP）的正常值范围，观察其在心、肺、糖尿病以及肾脏疾患中的改变及诊断截断点，探讨将BNP作为上述疾病临床诊断和治疗效果的标志物的可靠性。方法采用微粒子酶免分析法，对西安地区健康人群血浆样本258份，不同疾病的住院患者血浆372份，进行血浆BNP浓度检测。结果西安地区健康人群血浆BNP的正常值范围（微粒子酶免分析法）0～38pg／ml；血浆BNP浓度在糖尿病组、冠心病组、心肌梗死组、心衰组、肾病组和肺病组中的诊断截断点分别为38．94，46．70，71．95，115．69，80．17和66．35pg／ml，不同心血管疾病组与正常组BNP浓度差异均有非常显著性（P〈0．01）；肾脏疾病组与正常组BNP浓度差异显著（P〈0．05）；而糖尿病组、肺病组则显示无统计学意义。结论建立地区健康人群血浆BNP的正常值范围，对于当地患者相关疾病的诊断具有重要实用价值；诊断截断点的建立可提高对疾病诊断的准确率。血浆BNP浓度不仅是心衰的强预报因子，而且在其它心脏疾患及肾脏病变中均显著升高，进一步显示了其在心、肾疾病诊断和治疗中潜在的临床价值。

BNP和cTnI在脓毒症心肌功能障碍中的诊断意义

目的:通过比较脓毒症患者脑钠肽(BNP)和肌钙蛋白I(cTnI)水平,探讨其在脓毒症心肌功能障碍中的诊断意义。方法:共入选53例严重脓毒症患者,入院后24h进行心脏超声检查左室射血分数(LVEF),将患者分为29例LVEF>40%组和24例LVEF≤40%组,检测患者BNP和cTnI水平,记录APACHEⅡ评分,并进行比较分析。采用Pearson相关分析BNP、cTnI与APACHEⅡ评分相关性,BNP、cTnI与LVEF相关性。结果:两组患者BNP和cTnI均升高,LVEF≤40%组BNP明显高于LVEF>40%组,差异有统计学意义(P<0.05)。死亡组BNP和cTnI明显高于存活组,差异有统计学意义(P<0.05)。BNP、cTnI与APACHEⅡ评分存在相关性(r=0.43,P<0.05;r=0.39,P<0.05)。BNP与LVEF呈负相关(-r=0.31,P<0.05),cTnI与LVEF无显著相关(P>0.05)。结论:脓毒症心肌功能障碍患者BNP和cTnI水明显升高,且BNP和cTnI升高提示预后不良。

血浆B型利钠肽(BNP)在心功能不全中的诊断和治疗效果中的应用

目的探讨血浆B型利钠肽(BNP)的水平与心功能分级之间的相关性。方法采用美国博适(B iosite—Triagoe)床旁快速定量心力衰竭/心肌梗死诊断仪,测定368例心衰病人血浆中的BNP含量,其中20例病人于抗心衰治疗二周后复测血浆BNP,进行统计学分析。结果血浆BNP水平与美国NYHA(纽约心脏学会)心功能不全(CHF)的分级标准密切相关(P<0.05),心功能不全越严重,BNP值越高,而且反映心功能不全程度较超声心动图EF值更敏感,其中心功能Ⅲ、Ⅳ级各20例病人在经过抗心衰治疗2周后复测BNP,发现BNP都明显下降,但并不能降至正常。结论BNP值可作为较可靠的心功能不全的早期预测参考指标,也可作为判断心衰严重程度和疗效以及预测预后的指标,而且操作简便,易于重复。