pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2011-0-6-80-86pulmo-422Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESДиагностическая и прогностическая значимость концевого N-отрезка мозгового натрийуретического пептида (Nt-proBNP) при обострении хронической обструктивной болезни легкихDiagnostic and prognostic value of N-terminal-proB-type natriuretic peptide (NT-proBNP) in patient with acute exacerbations of COPDБаймакановаГ. Е.BaimakanovaG. E.

к. м. н., старший научный сотрудник лаборатории интенсивной терапии и дыхательной недостаточности 

105077, Москва, ул. 11-я Парковая, 32, корп. 4. Тел. / факс: (495) 465-74-15.

gulsara.bai@mail.ruАвдеевС. Н.AvdeevS. N.

д. м. н., проф., руководитель клинического отдела 

105077, Москва, ул. 11-я Парковая, 32, корп. 4. Тел. / факс: (495) 465-52-64.

serg_avdeev@list.ruФГУ "НИИ пульмонологии" ФМБА РоссииRussian Federation201128122011068086Copyright © Баймаканова Г.Е., Авдеев С.Н., 20112011Баймаканова Г.Е., Авдеев С.Н.Baimakanova G.E., Avdeev S.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/422

Резюме. Натрийуретические пептиды являются маркером сердечной недостаточности. Известна роль натрийуретического пептида NT-proBNP в качестве предиктора прогноза при критических состояниях.

Целью исследования была оценка диагностического и прогностического значения NT-proBNP у больных с обострением хронической обструктивной болезни легких (ХОБЛ). Исследование носило открытый проспективный дизайн. Были обследованы 80 госпитализированных пациентов с обострением ХОБЛ (возраст – 65,8 ± 19,9 года; объем форсированного выдоха за 1-ю с (ОФВ1) – 38,5 ± 17,3 %; парциальное напряжение кислорода (PaO2) и углекислого газа (PaCO2) – 53,8 ± 13,0 мм рт. ст. и 50,6 ± 15,1 мм рт. ст. соответственно). Всем пациентам выполнялось комплексное обследование (рентгенография легких, спирография, эхокардиография и серийные измерения уровня плазменного NT-proBNP). Основными причинами обострения ХОБЛ были гнойный бактериальный бронхит (48,8 %), пневмония (23,8 %), декомпенсация хронической сердечной недостаточности – ХСН (17,5 %) и тромбоэмболия легочных артерий – ТЭЛА (5 %). Уровень NT-proBNP был повышен у 88,7 % больных с обострением ХОБЛ, средняя концентрация NT-proBNP составила 1 057,8 ± 555,3 фмоль / мл. Пациенты с ХОБЛ и ТЭЛА имели самый высокий уровень NT-proBNP (1 735,9 ± 523,8 фмоль / мл); у пациентов с сочетанием ХОБЛ и ХСН уровень NT-proBNP – 1 405,4 ± 626,8 фмоль / мл, с пневмонией – 1 043,5 ± 643,1 фмоль / мл, с гнойным бронхитом – 906,6 ± 425,9 фмоль / мл. Значения Nt-pro BNP были выше у умерших, по сравнению с выжившими больными (1 484,6 ± 618,7 vs 1 003,7 ± 527,1 фмоль / мл соответственно; p = 0,013). Таким образом, у больных с обострением ХОБЛ плазменный уровень Nt-proBNP являлся эффективным маркером тяжести и прогноза болезни.

Summary. Natriuretic peptide is an important marker of the heart failure. NT-proBNP has also been shown to play a role in predicting outcomes in unselected cohort of critically ill patients.

This study was aimed at evaluation the diagnostic and prognostic value of NT-proBNP in patients with acute exacerbation of COPD (AECOPD). This was a prospective observational study enrolled 80 hospitalized patients with AECOPD (age, 65.8 ± 19.9 yrs; FEV1, 38.5 ± 17.3 %pred, PaO2, 53.8 ± 13.0 mmHg, PaCO2, 50.6 ± 15.1 mmHg). The patients underwent a comprehensive diagnostic algorithm including chest radiography, pulmonary function tests, echocardiography and serial measurements of plasma NT-proBNP (Biomedica). Main causes of acute exacerbation of COPD were purulent bronchitis (48.8 %), pneumonia (23.8 %), acute decompensation of chronic heart failure (ADCHF) (17.5 %), and pulmonary embolism (PE) (5 %). Mean plasma concentration of NT-proBNP in COPD patients was 1 057.8 ± 555.3 fmol / ml. NT-proBNP level was elevated in 88.7 % of the cases. Patients with AECOPD and PE had the highest level of NT-proBNP (1 735.9 ± 523.8 fmol / ml). NT-proBNP concentration in COPD patients with ADCHF was 1 405.4 ± 626.8 fmol / ml, in COPD patients with pneumonia – 1 043.5 ± 643.1 fmol / ml, and in COPD patients with purulent bronchitis – 906.6 ± 425.9 fmol / ml. In patients who died during hospital stay (8.4 %), plasma level of NT-proBNP was significantly higher than in survivors (1 484.6 ± 618.7 vs 1 003.7 ± 527.1, respectively, p = 0.013). Conclusions: Plasma level of NT-proBNP may be used as a marker of severity and prognosis in AECOPD.

хроническая обструктивная болезнь легкихобострениебиомаркерымозговой натрийуретический пептидchronic obstructive pulmonary diseaseexacerbationbiomarkersbrain natriuretic peptideReferencesGlobal Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI / WHO workshop report. The 2010 report is available on www.goldcopd.comGlobal Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI / WHO workshop report. The 2010 report is available on www.goldcopd.comSeemungal T.A.R., Donaldson G.C., Paul E.A. et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1998; 157: 1418–1422.Seemungal T.A.R., Donaldson G.C., Paul E.A. et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1998; 157: 1418–1422.Donaldson G.C., Seemungal T.A.R., Bhowmik A., Wedzicha J.A. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002; 57: 847–852.Donaldson G.C., Seemungal T.A.R., Bhowmik A., Wedzicha J.A. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002; 57: 847–852.Lacoma A., Prat C., Andreo F., Domlnguez J. Biomarkers in the management of COPD. Eur. Respir. Rev. 2009; 18 (112): 96–104.Lacoma A., Prat C., Andreo F., Domlnguez J. Biomarkers in the management of COPD. Eur. Respir. Rev. 2009; 18 (112): 96–104.Nocturnal Oxygen Therapy Trial Group. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Ann. Intern. Med. 1980; 93: 391–398.Nocturnal Oxygen Therapy Trial Group. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Ann. Intern. Med. 1980; 93: 391–398.Oswald-Mammosser M., Weitzenblum E., Quoix E. et al. Prognostic factors in COPD patients receiving long-term oxygen therapy: importance of pulmonary artery pressure. Chest 1995; 107: 1193–1198.Oswald-Mammosser M., Weitzenblum E., Quoix E. et al. Prognostic factors in COPD patients receiving long-term oxygen therapy: importance of pulmonary artery pressure. Chest 1995; 107: 1193–1198.Soler-Cataluna J.J., Martinez-Garcia M.A., Roman Sanchez P. et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax 2005; 60: 925–931.Soler-Cataluna J.J., Martinez-Garcia M.A., Roman Sanchez P. et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax 2005; 60: 925–931.Antonelli Incalzi R., Fuso L., De Rosa M. et al. Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur. Respir. J. 1997; 10: 2794–2800.Antonelli Incalzi R., Fuso L., De Rosa M. et al. Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur. Respir. J. 1997; 10: 2794–2800.Mueller C., Breidthardt T., Laule-Kilian K. et al. The integration of BNP and NT-proBNP into clinical medicine. Swiss. Med. Wkly 2007; 137: 4–12.Mueller C., Breidthardt T., Laule-Kilian K. et al. The integration of BNP and NT-proBNP into clinical medicine. Swiss. Med. Wkly 2007; 137: 4–12.Varpula M., Pulkki K., Karlsson S. et al. Predictive value of N-terminal pro-brain natriuretic peptide in severe sepsis and septic shock. Crit. Care Med. 2007; 35: 1277–1283.Varpula M., Pulkki K., Karlsson S. et al. Predictive value of N-terminal pro-brain natriuretic peptide in severe sepsis and septic shock. Crit. Care Med. 2007; 35: 1277–1283.Попова К.А., Авдеев СН. Значение натрийуретических пептидов в диагностике сердечной недостаточности и других заболеваний. Пульмонология 2006; 4: 106–111.Попова К.А., Авдеев СН. Значение натрийуретических пептидов в диагностике сердечной недостаточности и других заболеваний. Пульмонология 2006; 4: 106–111.Doust J.A., Glasziou P.P., Pietrzak E. et al. A systematic review of the diagnostic accuracy of natriuretic peptides for heart failure. Arch. Intern. Med. 2004; 164: 1978–1984.Doust J.A., Glasziou P.P., Pietrzak E. et al. A systematic review of the diagnostic accuracy of natriuretic peptides for heart failure. Arch. Intern. Med. 2004; 164: 1978–1984.Mueller T., Gegenhuber A., Poelz W. et al. Head-to-head comparison of the diagnostic utility of BNP and NT-proBNP in symptomatic and asymptomatic structural heart disease. Clin. Chim. Acta 2004; 341: 41–48.Mueller T., Gegenhuber A., Poelz W. et al. Head-to-head comparison of the diagnostic utility of BNP and NT-proBNP in symptomatic and asymptomatic structural heart disease. Clin. Chim. Acta 2004; 341: 41–48.Mueller T., Gegenhuber A., Poelz W. et al. Diagnostic accuracy of B type natriuretic peptide and amino terminal proBNP in the emergency diagnosis of heart failure. Heart 2005; 91: 606–612.Mueller T., Gegenhuber A., Poelz W. et al. Diagnostic accuracy of B type natriuretic peptide and amino terminal proBNP in the emergency diagnosis of heart failure. Heart 2005; 91: 606–612.Richards A.M., Nicholls M.G., Espiner E.A. et al. B-type natriuretic peptides and ejection fraction for prognosis after myocardial infarction. Circulation 2003; 107: 2786–2792.Richards A.M., Nicholls M.G., Espiner E.A. et al. B-type natriuretic peptides and ejection fraction for prognosis after myocardial infarction. Circulation 2003; 107: 2786–2792.Ray P., Arthaud M., Birolleau S. et al. Comparison of brain natriuretic peptide and probrain natriuretic peptide in the diagnosis of cardiogenic pulmonary edema in patients aged 65 and older. J. Am. Geriatr. Soc. 2005; 53: 643–648.Ray P., Arthaud M., Birolleau S. et al. Comparison of brain natriuretic peptide and probrain natriuretic peptide in the diagnosis of cardiogenic pulmonary edema in patients aged 65 and older. J. Am. Geriatr. Soc. 2005; 53: 643–648.Ishii J., Nomura M., Ito M. et al. Plasma concentration of brain natriuretic peptide as a biochemical marker for the evaluation of right ventricular overload and mortality in chronic respiratory disease. Clin. Chim. Acta 2000; 301: 19–30.Ishii J., Nomura M., Ito M. et al. Plasma concentration of brain natriuretic peptide as a biochemical marker for the evaluation of right ventricular overload and mortality in chronic respiratory disease. Clin. Chim. Acta 2000; 301: 19–30.Leuchte H.H., Holzapfel M., Baumgartner R.A. et al. Clinical significance of brain natriuretic peptide in primary pulmonary hypertension. J. Am. Coll. Cardiol. 2004; 43: 764–770.Leuchte H.H., Holzapfel M., Baumgartner R.A. et al. Clinical significance of brain natriuretic peptide in primary pulmonary hypertension. J. Am. Coll. Cardiol. 2004; 43: 764–770.Stolz D., Christ-Crain M., Morgenthaler N.G. et al. Copeptin, C-reactive protein, and procalcitonin as prognostic biomarkers in acute exacerbation of COPD. Chest 2007; 131: 1058–1067.Stolz D., Christ-Crain M., Morgenthaler N.G. et al. Copeptin, C-reactive protein, and procalcitonin as prognostic biomarkers in acute exacerbation of COPD. Chest 2007; 131: 1058–1067.Ruskoaho H. Cardiac hormones as diagnostic tools in heart failure. Endocr. Rev. 2003; 24: 341–356.Ruskoaho H. Cardiac hormones as diagnostic tools in heart failure. Endocr. Rev. 2003; 24: 341–356.Anthonisen N.R., Manfreda J., Warren C.P. et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann. Intern. Med. 1987; 106: 196–204.Anthonisen N.R., Manfreda J., Warren C.P. et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann. Intern. Med. 1987; 106: 196–204.Charlson M.E., Pompei P., Ales K.L., MacKenzie C.R. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chron. Dis. 1987; 40: 373–383.Charlson M.E., Pompei P., Ales K.L., MacKenzie C.R. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chron. Dis. 1987; 40: 373–383.Murray P.R., Washington J.A. Microscopic and bacteriologic analysis of expectorated sputum. Mayo Clin. Proc. 1975; 50: 339–344.Murray P.R., Washington J.A. Microscopic and bacteriologic analysis of expectorated sputum. Mayo Clin. Proc. 1975; 50: 339–344.National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility testing: Ninths Informational Supplement. Philadelphia, PA: NCCLS, 2001; vol. 21, (1).National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility testing: Ninths Informational Supplement. Philadelphia, PA: NCCLS, 2001; vol. 21, (1).Quanier P.H., Tammeling G.J., Cotes J.E. et al. Lung volumes and forced ventilatory flows. Eur. Respir. J. 1993; 6 (Suppl. 16): 5–40.Quanier P.H., Tammeling G.J., Cotes J.E. et al. Lung volumes and forced ventilatory flows. Eur. Respir. J. 1993; 6 (Suppl. 16): 5–40.Swedberg K., Cleland J., Dargie H. et al. The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005). Eur. Heart J. 2005; 26: 1115–1140.Swedberg K., Cleland J., Dargie H. et al. The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005). Eur. Heart J. 2005; 26: 1115–1140.Cheng V., Kazanagra R., Garcia A. et al. A rapid bedside test for B-type peptide predicts treatment outcomes in patients admitted for decompensated heart failure: a pilot study. J. Am. Coll. Cardiol. 2001; 37: 386–391.Cheng V., Kazanagra R., Garcia A. et al. A rapid bedside test for B-type peptide predicts treatment outcomes in patients admitted for decompensated heart failure: a pilot study. J. Am. Coll. Cardiol. 2001; 37: 386–391.Stolz D., Breidthardt N., Christ-Crain M. et al. Use of B-type natriuretic peptide in the risk stratification of acute exacerbations of COPD. Chest 2008; 133: 1088–1094.Stolz D., Breidthardt N., Christ-Crain M. et al. Use of B-type natriuretic peptide in the risk stratification of acute exacerbations of COPD. Chest 2008; 133: 1088–1094.Weinfeld M.S., Chertow G.M., Stevenson L.W. Aggravated renal dysfunction during intensive therapy for advanced chronic heart failure. Am. Heart J. 1999; 138: 285–290.Weinfeld M.S., Chertow G.M., Stevenson L.W. Aggravated renal dysfunction during intensive therapy for advanced chronic heart failure. Am. Heart J. 1999; 138: 285–290.Ma K.K., Ogawa T., de Bold A.J. Selective upregulation of cardiac brain natriuretic peptide at the transcriptional and translational levels by pro-inflammatory cytokines and by conditioned medium derived from mixed lymphocyte reactions via p38 MAP kinase. J. Mol. Cell. Cardiol. 2004; 36: 505–513.Ma K.K., Ogawa T., de Bold A.J. Selective upregulation of cardiac brain natriuretic peptide at the transcriptional and translational levels by pro-inflammatory cytokines and by conditioned medium derived from mixed lymphocyte reactions via p38 MAP kinase. J. Mol. Cell. Cardiol. 2004; 36: 505–513.Tanaka T., Kanda T., Takajashi T. et al. Interleukin-6 induced reciprocal expression of SERCA and natriuretic peptides mRNA in cultured rat ventricular myocytes. J. Int. Med. Res. 2004; 32: 57–61.Tanaka T., Kanda T., Takajashi T. et al. Interleukin-6 induced reciprocal expression of SERCA and natriuretic peptides mRNA in cultured rat ventricular myocytes. J. Int. Med. Res. 2004; 32: 57–61.Tomaru Ki K., Arai M., Yokoyama T. et al. Transcriptional activation of the BNP gene by lipopolysaccharide is mediated through GATA elements in neonatal rat cardiac myocytes. J. Mol. Cell. Cardiol. 2002; 34: 649–659.Tomaru Ki K., Arai M., Yokoyama T. et al. Transcriptional activation of the BNP gene by lipopolysaccharide is mediated through GATA elements in neonatal rat cardiac myocytes. J. Mol. Cell. Cardiol. 2002; 34: 649–659.Court O., Kumar A., Parrillo J.E. et al. Clinical review: Myocardial depression in sepsis and septic shock. Crit. Care 2002; 6: 500–508.Court O., Kumar A., Parrillo J.E. et al. Clinical review: Myocardial depression in sepsis and septic shock. Crit. Care 2002; 6: 500–508.Brueckmann M., Huhle G., Lang S. et al. Prognostic value of plasma N-terminal pro-brain natriuretic peptide in patients with severe sepsis. Circulation 2005; 26: 527–534.Brueckmann M., Huhle G., Lang S. et al. Prognostic value of plasma N-terminal pro-brain natriuretic peptide in patients with severe sepsis. Circulation 2005; 26: 527–534.Roch A., Allardet-Servent J., Michelet P. et al. NH2 terminal pro-brain natriuretic peptide plasma level as an early marker of prognosis and cardiac dysfunction in septic shock patients. Crit. Care Med. 2005; 33: 1001–1007.Roch A., Allardet-Servent J., Michelet P. et al. NH2 terminal pro-brain natriuretic peptide plasma level as an early marker of prognosis and cardiac dysfunction in septic shock patients. Crit. Care Med. 2005; 33: 1001–1007.Charpentier J., Luyt C.-E., Fulla Y. et al. Brain natriuretic peptide: A marker of myocardial dysfunction and prognosis during severe sepsis. Crit. Care Med. 2004; 32: 660–665.Charpentier J., Luyt C.-E., Fulla Y. et al. Brain natriuretic peptide: A marker of myocardial dysfunction and prognosis during severe sepsis. Crit. Care Med. 2004; 32: 660–665.Hoffmann U., Brueckmann M., Bertsch T. et al. Increased plasma levels of NT-proANP and NTproBNP as markers of cardiac dysfunction in septic patients. Clin. Lab. 2005; 51: 373–379.Hoffmann U., Brueckmann M., Bertsch T. et al. Increased plasma levels of NT-proANP and NTproBNP as markers of cardiac dysfunction in septic patients. Clin. Lab. 2005; 51: 373–379.Berendes E., Van Aken H., Raufhake C. et al. Differential secretion of atrial and brain natriuretic peptide in critically ill patients. Anesth. Analg. 2001; 93: 676–682.Berendes E., Van Aken H., Raufhake C. et al. Differential secretion of atrial and brain natriuretic peptide in critically ill patients. Anesth. Analg. 2001; 93: 676–682.Cuthbertson B.H., Patel R.R., Croal B.L. et al. B-type natriuretic peptide and the prediction of outcome in patients admitted to intensive care. Anaesthesia 2005; 60: 16–21.Cuthbertson B.H., Patel R.R., Croal B.L. et al. B-type natriuretic peptide and the prediction of outcome in patients admitted to intensive care. Anaesthesia 2005; 60: 16–21.Jefic D., Lee J.W., Jefic D. et al. Utility of B-type natriuretic peptide and N-terminal pro Btype natriuretic peptide in evaluation of respiratory failure in critically ill patients. Chest 2005; 128: 288–295.Jefic D., Lee J.W., Jefic D. et al. Utility of B-type natriuretic peptide and N-terminal pro Btype natriuretic peptide in evaluation of respiratory failure in critically ill patients. Chest 2005; 128: 288–295.Rudiger A., Gasser S., Fischler M. et al. Comparable increase of B-type natriuretic peptide and amino-terminal pro-B-type natriuretic peptide levels in patients with severe sepsis, septic shock, and acute heart failure. Crit. Care Med. 2006; 34: 2140–2144.Rudiger A., Gasser S., Fischler M. et al. Comparable increase of B-type natriuretic peptide and amino-terminal pro-B-type natriuretic peptide levels in patients with severe sepsis, septic shock, and acute heart failure. Crit. Care Med. 2006; 34: 2140–2144.Chien J.-Y., Lin V.-S., Huang Y.-C. et al. Changes in B-type natriuretic peptide improve weaning outcome predicted by spontaneous breathing trial. Crit. Care Med. 2008; 36: 1421–1426.Chien J.-Y., Lin V.-S., Huang Y.-C. et al. Changes in B-type natriuretic peptide improve weaning outcome predicted by spontaneous breathing trial. Crit. Care Med. 2008; 36: 1421–1426.Christ M., Thuerlimann A., Laule K. et al. Long-term prognostic value of B-type natriuretic peptide in cardiac and non-cardiac causes of acute dyspnoea. Eur. J. Clin. Invest. 2007; 37: 834–841.Christ M., Thuerlimann A., Laule K. et al. Long-term prognostic value of B-type natriuretic peptide in cardiac and non-cardiac causes of acute dyspnoea. Eur. J. Clin. Invest. 2007; 37: 834–841.Nagaya N., Nishikimi T., Uematsu M. et al. Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension. Circulation 2000; 102: 865–870.Nagaya N., Nishikimi T., Uematsu M. et al. Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension. Circulation 2000; 102: 865–870.Jelic S., Le Jemtel T.H. Diagnostic usefulness of B-type natriuretic peptide and functional consequences of muscle alterations in COPD and chronic heart failure. Chest 2006; 130: 1220–1230.Jelic S., Le Jemtel T.H. Diagnostic usefulness of B-type natriuretic peptide and functional consequences of muscle alterations in COPD and chronic heart failure. Chest 2006; 130: 1220–1230.Grasso S., Leone A., De Michele M. et al. Use of N-terminal pro-brain natriuretic peptide to detect acute cardiac dysfunction during weaning failure in difficult-to-wean patients with chronic obstructive pulmonary disease. Crit. Care Med. 2007; 35: 96–105.Grasso S., Leone A., De Michele M. et al. Use of N-terminal pro-brain natriuretic peptide to detect acute cardiac dysfunction during weaning failure in difficult-to-wean patients with chronic obstructive pulmonary disease. Crit. Care Med. 2007; 35: 96–105.Abroug F., Ouanes-Besbes L., Nciri N. et al. Left heart dysfunction and severe exacerbation of COPD: Diagnostic performance of cardiac biomarkers. Am. J. Respir. Crit. Care Med. 2006; 174: 990–996.Abroug F., Ouanes-Besbes L., Nciri N. et al. Left heart dysfunction and severe exacerbation of COPD: Diagnostic performance of cardiac biomarkers. Am. J. Respir. Crit. Care Med. 2006; 174: 990–996.Tung R.H., Camargo C.A., Krauser D. Amino-terminal probrain natriuretic peptide for the diagnosis of acute heart failure in patients with previous obstructive airway disease. Ann. Emerg. Med. 2006; 48: 66–74.Tung R.H., Camargo C.A., Krauser D. Amino-terminal probrain natriuretic peptide for the diagnosis of acute heart failure in patients with previous obstructive airway disease. Ann. Emerg. Med. 2006; 48: 66–74.

The authors declare that there are no conflicts of interest present.