Trojnarska Olga, Szyszka Andrzej, Gwizdała Adrian, Siniawski Andrzej, Oko-Sarnowska Zofia, Chmara Ewa, Katarzyński Sławomir, Cieśliński Andrzej
Ist Department of Cardiology of University of Medical Sciences in Poznan, Poland.
Int J Cardiol. 2006 Jun 7;110(1):86-92. doi: 10.1016/j.ijcard.2005.07.025. Epub 2005 Oct 19.
Adult patients after surgical repair of Fallot's tetralogy usually present with satisfactory exercise capacity years after the original procedure, though they never tolerate as high levels of exercise as their healthy counterparts. The aim of the study was to assess exercise capacity with cardiopulmonary stress test and BNP levels in adult survivors of surgical repair of Fallot's tetralogy. We studied 60 patients with no or only mild symptoms (including 29 males), at the mean age of 27.6+/-8.2 years at the time of follow-up screening, operated on at the age of 7.5+/-5.3 years. In 34 patients moderate to severe pulmonary regurgitation (PR+) was observed. Control group consisted of 28 healthy volunteers (13 males), aged 28.7+/-5.1 years. Peak oxygen uptake (VO2) in studied group was found to be significantly lower than in control group (24.7+/-5.5 vs. 36.6+/-7.6 ml/kg/min, p=0.00001), VE/VCO2 slope, the marker of respiratory effort, was higher in surgical treatment group as compared to the control group (36.5+/-6.3 vs. 29.7+/-4.7, p=0.004). In patients with PR+, peak VO2% was higher than in PR- individuals (69.6+/-11.8% vs. 58.5+/-12.1%, p=0.0005). The BNP concentration in the studied group (34.8+/-27.1 pg/ml) was higher than in healthy subjects (11.5+/-6.5 pg/ml, p=0.00001). Levels of BNP correlated inversely with peak VO2 (r=-0.286, p=0.03), FVC (r=-0.265 p=0.04) and positively with VE/VCO2 (r=0.361, p=0.005). Additionally the levels of BNP correlated positively with the age of patients at the time of surgical repair (r=0.250, p=0.04). We concluded that exercise capacity in adults after repair of Fallot's tetralogy, especially those PR+, was lower than in healthy volunteers. Concentrations of BNP in surgical treatment survivors were higher and correlated well with cardiopulmonary stress study parameters.
法洛四联症手术修复后的成年患者在最初手术后数年通常表现出令人满意的运动能力，尽管他们的运动耐量从未达到健康同龄人那样的高水平。本研究的目的是通过心肺应激试验和脑钠肽（BNP）水平评估法洛四联症手术修复成年幸存者的运动能力。我们研究了60例无或仅有轻微症状的患者（包括29例男性），随访筛查时的平均年龄为27.6±8.2岁，手术年龄为7.5±5.3岁。在34例患者中观察到中度至重度肺动脉反流（PR+）。对照组由28名健康志愿者（13名男性）组成，年龄为28.7±5.1岁。研究组的峰值摄氧量（VO2）显著低于对照组（24.7±5.5 vs. 36.6±7.6 ml/kg/min，p = 0.00001），呼吸努力标志物VE/VCO2斜率在手术治疗组高于对照组（36.5±6.3 vs. 29.7±4.7，p = 0.004）。在PR+患者中，峰值VO2%高于PR-患者（69.6±11.8% vs. 58.5±12.1%，p = 0.0005）。研究组的BNP浓度（34.8±27.1 pg/ml）高于健康受试者（11.5±6.5 pg/ml，p = 0.00001）。BNP水平与峰值VO2呈负相关（r = -0.286，p = 0.03），与用力肺活量（FVC）呈负相关（r = -0.265，p = 0.04），与VE/VCO2呈正相关（r = 0.361，p = 0.005）。此外，BNP水平与手术修复时患者的年龄呈正相关（r = 0.250，p = 0.04）。我们得出结论，法洛四联症修复后的成年患者，尤其是PR+患者，运动能力低于健康志愿者。手术治疗幸存者的BNP浓度较高，且与心肺应激研究参数相关性良好。
