The Department of Pediatric Cardiology, Chiba Children's Hospital, Chiba-city, Chiba, Japan.
Int J Cardiol. 2012 Aug 23;159(2):88-93. doi: 10.1016/j.ijcard.2011.02.023. Epub 2011 Mar 12.
Recent studies showed that children with univentricular heart have elevated plasma B-type natriuretic peptide (BNP) levels prior to bidirectional cavopulmonary anastomosis (BDCPA). However, it remains to be established whether BNP levels reflect the degree of hemodynamic overload and relate to long-term outcome in univentricular circulation.
Fifty one consecutive children with functionally univentricular heart prior to BDCPA were studied. All patients underwent cardiac catheterization and BNP measurement. Ventricular end-systolic wall stress (ESWS) and end-diastolic wall stress (EDWS) were calculated from cardiac catheterization data.
Median age was 1.1 years and 34% were female. Median BNP concentration was 90.4 pg/ml. Patients with high BNP (≥ 100 pg/ml) had higher pulmonary to systemic flow ratio (p = 0.014), a greater end-diastolic volume (p=0.009), more severe atrioventricular valve regurgitation (p= 0.02) and lower ventricular mass to end-diastolic volume ratio (p=0.006). BNP levels strongly related to EDWS (r = 0.75, p< 0.0001) and ESWS (r = 0.63, p < 0.0001). During median follow-up period of 3.2 years, 15 patients died and one underwent heart transplantation for refractory heart failure. On multivariate Cox regression analysis, high BNP concentration was an independent predictor of death or transplantation (HR 3.05, CI: 1.06-8.83, p = 0.04).
High BNP concentration at the first palliative stage towards Fontan circulation reflects high wall stress due to high volume load and insufficient ventricular hypertrophy. Moreover, high BNP levels at this stage were independently related to long-term outcome. BNP may be used as a guide to identify patients with high workload due to inadequate adaptation to hemodynamic load, who are at high risk.
最近的研究表明，在双向腔肺吻合术（BDCPA）之前，单心室心脏患儿的血浆 B 型利钠肽（BNP）水平升高。然而，BNP 水平是否反映了血液动力学超负荷的程度，并与单心室循环的长期预后相关，仍有待确定。
研究了 51 例在 BDCPA 前功能单心室心脏的连续患儿。所有患者均接受了心导管检查和 BNP 测量。从心导管数据计算心室收缩末期壁应力（ESWS）和舒张末期壁应力（EDWS）。
中位年龄为 1.1 岁，34%为女性。中位 BNP 浓度为 90.4pg/ml。BNP 较高（≥100pg/ml）的患者肺动脉与体循环血流量比更高（p=0.014），舒张末期容积更大（p=0.009），房室瓣反流更严重（p=0.02），心室质量与舒张末期容积比更低（p=0.006）。BNP 水平与 EDWS（r=0.75，p<0.0001）和 ESWS（r=0.63，p<0.0001）呈强相关。在中位 3.2 年的随访期间，15 名患者死亡，1 名患者因难治性心力衰竭接受心脏移植。多变量 Cox 回归分析显示，高 BNP 浓度是死亡或移植的独立预测因子（HR 3.05，CI：1.06-8.83，p=0.04）。
Fontan 循环前姑息治疗的第一阶段高 BNP 浓度反映了由于高容量负荷和心室肥厚不足而导致的高壁应力。此外，该阶段的高 BNP 水平与长期预后独立相关。BNP 可作为识别因对血液动力学负荷适应不足而导致高工作量的患者的指标，这些患者风险较高。
