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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">medalphabet</journal-id><journal-title-group><journal-title xml:lang="ru">Медицинский алфавит</journal-title><trans-title-group xml:lang="en"><trans-title>Medical alphabet</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2078-5631</issn><issn pub-type="epub">2949-2807</issn><publisher><publisher-name>ООО «Альфмед»</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.33667/2078-5631-2025-3-21-29</article-id><article-id custom-type="elpub" pub-id-type="custom">medalphabet-4294</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>Статьи</subject></subj-group></article-categories><title-group><article-title>Информативность кардиального биомаркера NT-proBNP в ранние сроки после реваскуляризации миокарда в условиях искусственного кровообращения (пилотное исследование)</article-title><trans-title-group xml:lang="en"><trans-title>Informativity of the cardiac biomarker NT-proBNP early after on-pump coronary artery bypass grafting (pilot study)</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1910-0207</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Козлов</surname><given-names>И. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Kozlov</surname><given-names>I. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Козлов Игорь Александрович, д.м.н., профессор кафедры анестезиологии и реаниматологииМосковская область, Россия</p></bio><bio xml:lang="en"><p>Kozlov Igor A., DM Sci (habil.), professor at Dept of Anesthesiology and ReanimatologyMoscow, Russia</p></bio><email xlink:type="simple">iakozlov@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-8886-7175</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Кричевский</surname><given-names>Л. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Krichevskiy</surname><given-names>L. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кричевский Лев Анатольевич, д.м.н., зав. отделением анестезиологииреанимации № 22, зав. кафедрой анестезиологии и реаниматологииМосква</p></bio><bio xml:lang="en"><p>Krichevskiy Lev A., DM Sci (habil.), Head of  Anesthesiology and Intensive Care Department № 22, Head of Anesthesiology and Renimatology DepartmentMoscow, Russia</p></bio><email xlink:type="simple">levkrich72@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-3020-6873</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Рыбаков</surname><given-names>В. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Rybakov</surname><given-names>V. Yu.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Рыбаков Владислав Юрьевич, врач-анестезиолог</p></bio><bio xml:lang="en"><p>Rybakov Vladislav Yu., anesthesiologist Moscow, Russia</p></bio><email xlink:type="simple">vladrybakoff@gmail.com</email><xref ref-type="aff" rid="aff-3"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ГБУЗ «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>M. F. Vladimirsky Moscow Regional Research Clinical Institute</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ГБУЗ «Городская клиническая больница имени С.С. Юдина Департамента здравоохранения города Москвы»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>S. S. Yudin City Clinical Hospital</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Russian Medical Academy of Continuing Professional Education</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2025</year></pub-date><pub-date pub-type="epub"><day>24</day><month>04</month><year>2025</year></pub-date><volume>0</volume><issue>3</issue><issue-title>Кардиология. Неотложная медицина (1)</issue-title><fpage>21</fpage><lpage>29</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Козлов И.А., Кричевский Л.А., Рыбаков В.Ю., 2025</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="ru">Козлов И.А., Кричевский Л.А., Рыбаков В.Ю.</copyright-holder><copyright-holder xml:lang="en">Kozlov I.A., Krichevskiy L.A., Rybakov V.Y.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.med-alphabet.com/jour/article/view/4294">https://www.med-alphabet.com/jour/article/view/4294</self-uri><abstract><p>Цель исследования: оценить взаимосвязи уровня N-терминального отрезка предшественника натрийуретического пептида В-типа (NTproBNP) с показателями кровообращения после операций по поводу ишемической болезни сердца (ИБС) в условиях искусственного кровообращения (ИК) и изучить ассоциированность биомаркера с проявлениями миокардиальной дисфункции. Материал и методы. Обследовали 38 больных ИБС в возрасте 55,0±1,5 лет, которым выполнили реваскуляризацию миокарда (РМ). Определение уровня NT-proBNP, оценку центральной гемодинамики (ЦГД) и чреспищеводную эхокардиографию (ЧПэхоКГ) выполняли в течение первого часа после поступления больных в отделение реанимации и интенсивной терапии (ОРИТ). Использовали корреляционный анализ, логистическую регрессию с расчетом отношения шансов (ОШ) и 95% доверительного интервала (95% ДИ) и ROC-анализ с расчетом площади под ROC-кривой (ППК). Результаты. В 52,6% наблюдений значения NT-proBNP были нормальными и составили 179,75[112,65–237,5] пг/мл, у 47,4% больных уровень биомаркера был повышен до615,25[425,7–1158,0] пг/мл. Содержание NT-proBNP в крови не коррелировало с данными инвазивного мониторинга ЦГД и умеренно коррелировало с параметрами ЧПэхоКГ. Значения NT-proBNP &gt;366 пг/мл ассоциировались синдексом конечно-систолической площади (ИКСП) левого желудочка (ЛЖ) &gt;9 см2 /м2 (ОШ 1,0032, 95% ДИ 1,0009–1,0054, р=0,006, ППК 0,847), значения &gt;440 пг/мл – с фракцией сокращения площади (ФСП) ЛЖ &lt;40% (ОШ 1,0021, 95%-ный ДИ 1,0001–1,0042, р=0,036, ППК 0,750) и с индексом конечно-диастолической площади (ИКДП) ЛЖ &gt;15 см2 /м2 (ОШ 1,0029, 95%-ный ДИ 1,0002–1,0055, р=0,032, ППК 0,865). Уровень биомаркера &lt;272 пг/мл дискриминировал больных с отсутствием потребности в послеоперационной инотропной поддержке (ОШ 0,9973, 95% ДИ 0,9947–0,9999, р=0,041, ППК 0,737), а значения &gt;385 пг/мл были предикторами длительности лечения в ОРИТ &gt;24 ч (ОШ 1,0029, 95% ДИ 1,0008–1,0050, р=0,008, ППК 0,731). Уровень NT-proBNP &gt;505 пг/мл ассоциировался с вазоактивно-инотропным индексом &gt;10 (ОШ 1,0026, 95% ДИ 1,0006–1,0046, р=0,010, ППК 0,769), а уровень &gt;701 пг/мл – с проявлениями рефрактерной острой сердечной недостаточности (СН) (ОШ 1,0066, 95% ДИ 1,0012–1,0120, р=0,017, ППК 0,976). Заключение. При поступлении в ОРИТ медиана содержания NT-proBNP у больных, перенесших РМ с ИК, находилась в пределах нормы и составляет 305,0[176,2–604,5] пг/мл. Значения биомаркера на этом этапе лечения умеренно коррелировали с дооперационными эхокардиографическими показателями систолической функции ЛЖ. В ранние сроки после поступления больных в ОРИТ уровень NT-proBNP в пределах 366–448 пг/мл ассоциировался с признаками миокардиальной дисфункции, включая ИКСПЛЖ&gt;9 см2/м2, ИКДПЛЖ&gt;15 см2/ м2 , ФСПЛЖ&lt;40% и длительностью лечения в ОРИТ&gt;24 ч. Значения биомаркера в диапазоне 505–701 пг/мл ассоциировался с клиническими проявлениями тяжелой послеоперационной СН.</p></abstract><trans-abstract xml:lang="en"><p>The objective: to study the relationship between the blood levels of the N-terminal segment of B-type natriuretic peptide precursor (NT-proBNP) and hemodynamic parameters after on-pump ischemic heart disease (IHD) surgeries, and to evaluate the  biomarker association with myocardial dysfunction manifestations. Material and methods. The study involved 38 patients aged 55,0±1,5 years with IHD who underwent coronary arteries bypass grafting (CABG). NT-proBNP blood level, pulmonary artery  catheterization (PAC) data, and transpesophageal echocardiography (TEE) data were studied within the first hour of admission to the intensive care unit (ICU). Correlation analysis, logistic regression with calculation of odds ratio (OR) and 95% confidence interval  (95% CI) and ROC analysis with calculation of area under ROC curve (AUC) were used. Results. In 52.6% of patients, NT-proBNP blood level was normal (179.75 [112.65–237.5] pg/ml), and in 47.4% of patients the biomarker level was increased (615.25 [425.7–1158.0] pg/ml). NT-proBNP blood level was not correlated with PAC data and moderately correlated with TEE parameters. NT-proBNP &gt;366 pg/mL were associated with left ventricular (LV) end-systolic area index (LVESAI) &gt;9 cm2 /m2 (OR1.0032, 95% CI 1.0009–1.0054, p = 0.006, AUC0.847), NTproBNP &gt;440 pg/mL were associated with LV area contraction fraction (LVACF) &lt;40% (OR1.0021, 95% CI 1.0001–1.0042, p = 0.036, AUC0.750) and with LV end-diastolic area index (LVEDAI) &gt;15 cm2 /m2 (OR1.0029, 95% CI 1.0002–1.0055, p = 0.032, AUC0.865). NT-proBNP &lt;272 pg/mL identified patients without postoperative inotropic support (OR0.9973, 95% CI 0.9947–0.9999, p=0.041, AUC0.737), and NT-proBNP &gt;385 pg/mL was a predictor of ICU length of stay &gt;24 hours (OR1.0029, 95% CI 1.0008–1.0050, p = 0.008, AUC0.731). NT-proBNP &gt;505 pg/mL was associated with a vasoactive-inotropic index &gt;10 (OR1.0026, 95% CI 1.0006–1.0046, p = 0.010, AUC0.769), and NT-proBNP &gt;701 pg/mL was a predictor of the refractory heart failure (HF) (OR1.0066, 95% CI 1.0012–1.0120, p = 0.017, AUC0.976). Conclusion. On admission to the ICU, the median NT-proBNP content in patients who underwent on-pump CABG was within the normal range and amounted to 305.0 [176.2–604.5] pg/ml. Biomarker at this stage of treatment moderately correlated with preoperative echocardiographic indices of LV systolic function. In the early period after admission of patients to the ICU, NT-proBNP levels within 366–448 pg/ml are associated with signs of myocardial dysfunction, including LVESAI &gt;9 cm2/m2, LVEDAI &gt;15 cm2/m2, LVACF &lt;40% and ICU length of stay &gt;24 h. NT-proBNP in the range of 505–701 pg/ml were associated with severe postoperative HF clinical sings.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>N-терминальный отрезок предшественника натрийуретического пептида В-типа</kwd><kwd>NT-proBNP</kwd><kwd>ишемическая болезнь сeрдца</kwd><kwd>реваскуляризация миокарда с искусственным кровообращением</kwd><kwd>аортокоронарное шунтирование</kwd><kwd>послеоперационная дисфункция миокарда</kwd></kwd-group><kwd-group xml:lang="en"><kwd>N-terminal segment of B-type natriuretic peptide precursor</kwd><kwd>NT-proBNP</kwd><kwd>ischemic heart disease</kwd><kwd>on-pump myocardial revascularization</kwd><kwd>coronary artery bypass grafting</kwd><kwd>postoperative myocardial dysfunction</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Tsutsui H., Albert N.M., Coats A.J.S., Anker S.D., Bayes-Genis A., Butler J., Chioncel O., Defilippi C.R., Drazner M.H., Felker G.M., Filippatos G., Fiuzat M., Ide T., Januzzi J.L. 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