Law Yuk Ming, Ettedgui Jose, Beerman Lee, Maisel Alan, Tofovic Stevan
Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA.
Am J Cardiol. 2006 Aug 15;98(4):520-4. doi: 10.1016/j.amjcard.2006.02.058. Epub 2006 Jun 27.
The measurement of plasma B-type natriuretic peptide (BNP) has emerged as a useful biomarker of heart failure in patients with cardiomyopathy. The pathophysiology of heart failure in single ventricle (SV) circulation may be distinct from that of cardiomyopathies. A distinct pattern of BNP elevation in heart failure in the SV population was hypothesized: it is elevated in heart failure secondary to ventricular dysfunction but not in isolated cavopulmonary failure. BNP was measured prospectively in SV patients at catheterization (n = 22) and when assessing for heart failure (n = 11) (7 normal controls). Of 33 SV subjects (median age 62 months), 13 had aortopulmonary connections and 20 had cavopulmonary connections. Median and mean +/- SD BNP levels by shunt type were 184 and 754 +/- 1,086 pg/ml in the patients with aortopulmonary connections, 38 and 169 +/- 251 pg/ml in the patients with cavopulmonary connections, and 10 and 11 +/- 5 pg/ml in normal controls, respectively (p = 0.004). Median systemic ventricular end-diastolic pressure (8mm Hg, R = 0.45), mean pulmonary artery pressure (14.5 mm Hg, R = 0.62), and mean right atrial pressure (6.5 mm Hg, R = 0.54) were correlated with plasma BNP. SV subjects with symptomatic heart failure from dysfunctional systemic ventricles had median and mean +/- SD BNP levels of 378 and 714 +/- 912 pg/ml (n = 18) compared with patients with isolated failed Glenn or Fontan connections (19 and 23 +/- 16 pg/ml [n = 7, p = 0.001]) and those with no heart failure (22 and 22 +/- 12 pg/ml [n = 8, p = 0.001]). Excluding the group with cavopulmonary failure, the severity of heart failure from systemic ventricular dysfunction was associated with plasma BNP. In conclusion, plasma BNP is elevated in SV patients with systemic ventricular or left-sided cardiac failure. BNP is not elevated in patients missing a pulmonary ventricle with isolated cavopulmonary failure.
血浆B型利钠肽（BNP）的测定已成为心肌病患者心力衰竭的一种有用生物标志物。单心室（SV）循环中心力衰竭的病理生理学可能与心肌病不同。有人推测，SV人群心力衰竭时BNP升高的模式独特：继发于心室功能障碍的心力衰竭时BNP升高，但孤立的腔肺分流衰竭时不升高。对SV患者在导管插入术时（n = 22）以及评估心力衰竭时（n = 11）（7名正常对照）进行了BNP的前瞻性测量。33名SV受试者（中位年龄62个月）中，13人有主肺动脉连接，20人有腔肺连接。按分流类型，主肺动脉连接患者的BNP中位值和均值±标准差分别为184和754±1086 pg/ml，腔肺连接患者为38和169±251 pg/ml，正常对照为10和11±5 pg/ml（p = ０.００４）。全身心室舒张末期压力中位数（8mmHg，R = 0.45）、平均肺动脉压（14.5 mmHg，R = 0.62）和平均右心房压（6.5 mmHg，R = 0.54）与血浆BNP相关。因功能不全的全身心室出现症状性心力衰竭的SV受试者，其BNP中位值和均值±标准差为378和714±912 pg/ml（n = 18），而孤立的Glenn或Fontan分流失败患者为19和23±16 pg/ml（n = 7，p = 0.001），无心力衰竭患者为22和22±12 pg/ml（n = 8，p = 0.001）。排除腔肺分流衰竭组后，全身心室功能障碍所致心力衰竭的严重程度与血浆BNP相关。总之，有全身心室或左侧心力衰竭的SV患者血浆BNP升高。孤立的腔肺分流衰竭且无肺心室的患者BNP不升高。
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