The Division of Adult Congenital Heart Disease, The Heart Hospital, University CollegeLondon Hospitals NHS Foundation Trust, London, UK.
Heart. 2010 Oct;96(19):1569-73. doi: 10.1136/hrt.2010.198648. Epub 2010 Aug 18.
Heart failure is common late after Senning or Mustard palliation of transposition of the great arteries (TGA). Although cardiac magnetic resonance (CMR) is the gold standard for evaluating systemic right ventricular performance, additional information regarding heart failure status might be gleaned from the surface ECG and circulating N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. The interrelationships between these heart failure markers were examined in adults late after Mustard and Senning surgery.
Thirty-five consecutive adults with Senning or Mustard repair of TGA attending a dedicated congenital heart failure clinic were studied. Assessment included symptom assessment, venous blood sampling for measurement of circulating NT-proBNP levels, surface 12-lead ECG and CMR for the assessment of right ventricular systolic function and determination of indexed right ventricular volumes.
Mean age was 29 ± 6.5 years, 54% had undergone Mustard surgery. Compared with those with uncomplicated surgery, patients with complex surgical history had higher NT-proBNP levels (55 ± 26 vs 20 ± 35 pmol/l; p=0.002) and longer QRS duration (116 ± 28 ms vs 89 ± 11 ms; p=0.0004) while showing no difference in New York Heart Association class and right ventricular function. There was a significant relationship between diastolic and systolic right ventricular volumes and both NT-proBNP levels (r=0.43, p=0.01; r=0.53, p=0.001, respectively) and QRS duration (r=0.47, p=0.004; r=0.53, p=0.001, respectively).
Circulating NT-proBNP levels and several surface ECG parameters constitute safe, cost-effective and widely available surrogate markers of systemic right ventricular function and provide additional information on heart failure status. Both measures hold promise as prognostic markers and their association with long-term outcome should be determined.
大动脉转位（TGA）患者行 Senning 或 Mustard 姑息手术后，常会出现心力衰竭。虽然心脏磁共振（CMR）是评估系统性右心室功能的金标准，但从体表心电图（ECG）和循环 N 末端脑利钠肽前体（NT-proBNP）水平中可能获得有关心力衰竭状态的其他信息。本研究旨在检查 Mustard 和 Senning 手术后患者这些心力衰竭标志物之间的相互关系。
连续纳入 35 例接受 Senning 或 Mustard 修复 TGA 的成年患者，这些患者在专门的先天性心力衰竭门诊就诊。评估包括症状评估、静脉采血测量循环 NT-proBNP 水平、体表 12 导联 ECG 和 CMR 评估右心室收缩功能以及确定右心室指数化容积。
平均年龄为 29±6.5 岁，54%的患者接受了 Mustard 手术。与手术简单的患者相比，有复杂手术史的患者 NT-proBNP 水平更高（55±26 比 20±35 pmol/L；p=0.002），QRS 间期更长（116±28 比 89±11 ms；p=0.0004），但纽约心脏协会（NYHA）心功能分级和右心室功能无差异。右心室舒张和收缩容积与 NT-proBNP 水平（r=0.43，p=0.01；r=0.53，p=0.001）和 QRS 间期（r=0.47，p=0.004；r=0.53，p=0.001）均存在显著相关性。
循环 NT-proBNP 水平和一些体表 ECG 参数是系统性右心室功能的安全、经济有效的广泛可用替代标志物，并提供有关心力衰竭状态的其他信息。这两种方法均有望作为预后标志物，应确定其与长期预后的关系。
