Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
J Am Coll Cardiol. 2013 Sep 24;62(13):1203-12. doi: 10.1016/j.jacc.2013.07.019. Epub 2013 Jul 31.
The aim of this study was to determine the value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in adults with congenital heart disease (CHD) and investigate its relationship with ventricular function and exercise capacity.
NT-proBNP may detect early deterioration in cardiac function.
In this cross-sectional study, extensive echocardiography, exercise testing, and NT-proBNP measurements were performed on the same day in consecutive adult patients with CHD.
In total, 475 patients were included in this study (mean age of 34 ± 12 years, 57% male, 90% New York Heart Association class I). The median NT-proBNP level was 15.1 pmol/l (interquartile range [IQR]: 7.1 to 31.3 pmol/l), and the NT-proBNP level was >14 pmol/l in 53% of patients. The highest NT-proBNP levels were observed in patients with Fontan circulation (36.1 pmol/l [IQR: 14.4 to 103.8 pmol/l]) and a systemic right ventricle (RV) (31.1 pmol/l [IQR: 21.8 to 56.0 pmol/l]), and the lowest values were seen in patients with aortic coarctation (7.3 pmol/l [IQR: 2.8 to 19.5 pmol/l]). NT-proBNP levels correlated with age (r = 0.39, p < 0.001) and were higher in women (median of 21.7 vs. 10.4 pmol/l; p < 0.001). In patients with aortic stenosis or aortic coarctation, NT-proBNP levels correlated with diastolic function parameters of E/E' ratio (r = 0.40, p < 0.001) and left atrial dimension (r = 0.36, p < 0.001). In patients with a systemic RV, NT-proBNP levels correlated with RV annulus diameter (r = 0.31, p = 0.024). In patients with tetralogy of Fallot, the strongest correlations were observed with left atrial dimension (r = 0.46, p < 0.001) and left ventricular ejection fraction (r = 0.37, p < 0.001). NT-proBNP levels were associated with exercise capacity (n = 198) (maximum workload: β = -0.08, p = 0.021) and peak oxygen uptake (β = -0.012, p = 0.011) in a multivariable regression model adjusted for age and sex.
NT-proBNP levels in adults with CHD clearly differ by diagnosis and are related to echocardiographic parameters and exercise capacity. Disease-specific correlations contribute to the understanding of the main hemodynamic problems per diagnosis. Follow-up data are needed to elucidate the additional prognostic value.
本研究旨在确定 N 末端 B 型利钠肽前体（NT-proBNP）在先天性心脏病（CHD）成人患者中的价值，并探讨其与心室功能和运动能力的关系。
NT-proBNP 可能检测到心脏功能的早期恶化。
在这项横断面研究中，连续的 CHD 成年患者在同一天进行了广泛的超声心动图、运动测试和 NT-proBNP 测量。
本研究共纳入 475 例患者（平均年龄 34 ± 12 岁，57%为男性，90%为纽约心脏协会心功能分级 I 级）。中位 NT-proBNP 水平为 15.1 pmol/L（四分位距 [IQR]：7.1 至 31.3 pmol/L），53%的患者 NT-proBNP 水平>14 pmol/L。NT-proBNP 水平最高的是 Fontan 循环（36.1 pmol/L [IQR：14.4 至 103.8 pmol/L]）和右心室（RV）系统（31.1 pmol/L [IQR：21.8 至 56.0 pmol/L]），最低的是主动脉缩窄（7.3 pmol/L [IQR：2.8 至 19.5 pmol/L]）。NT-proBNP 水平与年龄相关（r = 0.39，p < 0.001），女性更高（中位数分别为 21.7 比 10.4 pmol/L；p < 0.001）。在主动脉瓣狭窄或主动脉缩窄患者中，NT-proBNP 水平与舒张功能参数 E/E' 比值（r = 0.40，p < 0.001）和左心房内径（r = 0.36，p < 0.001）相关。在 RV 系统患者中，NT-proBNP 水平与 RV 瓣环直径相关（r = 0.31，p = 0.024）。在法洛四联症患者中，与左心房内径（r = 0.46，p < 0.001）和左心室射血分数（r = 0.37，p < 0.001）相关性最强。在调整年龄和性别后的多变量回归模型中，NT-proBNP 水平与运动能力（n = 198）（最大工作量：β = -0.08，p = 0.021）和峰值摄氧量（β = -0.012，p = 0.011）相关。
CHD 成人的 NT-proBNP 水平明显因诊断而异，与超声心动图参数和运动能力相关。特定疾病的相关性有助于了解每种诊断的主要血流动力学问题。需要随访数据来阐明其附加预后价值。
