Paolino Annalisa, Hussain Tarique, Pavon Antonio, Velasco Maria Nieves, Uribe Sergio, Ordoñez Antonio, Valverde Israel
Paediatric Cardiology Unit, Hospital Virgen del Rocio, Seville, Spain.
Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St. Thomas' Hospital, King's College London, London, UK.
Pediatr Cardiol. 2017 Feb;38(2):324-331. doi: 10.1007/s00246-016-1516-2. Epub 2016 Nov 21.
The goal of this study is to evaluate whether NT-proBNP plasma levels may help as a screening biomarker for monitoring right ventricular dilatation, pulmonary regurgitation and the onset of heart failure in patients with repaired Tetralogy of Fallot. Our single-centre observational prospective study involved 43 patients (15.1 years, SD = 8) with corrected Tetralogy of Fallot. Data collection included: clinical parameters (electrocardiogram, chest X-ray, NYHA scale, time since last surgery), biochemistry (NT-proBNP levels) and MRI values (ventricular volumetry, pulmonary flow assessment). Mean time since last surgery was 13.5 years (SD = 7.8). There was a statistically significant correlation between the NT-proBNP levels (187.4 pg/ml, SD = 154.9) and right ventricular dilatation for both the right ventricular end-diastolic volume (124.9 ml/m, SD = 31.2) (Pearson = 0.19, p < 0.01) and end-systolic volume (56.1 ml/m, SD = 18.8) (Pearson = 0.21, p < 0.01) and also with the pulmonary regurgitation fraction (36.5%, SD = 16, Pearson = 0.12, p < 0.01). No significant correlation was found between NT-proBNP and right ventricular ejection fraction (54.6%, SD = 10.6, Pearson = -0.07), left ventricular ejection fraction (59.9%, SD = 7.1, Pearson = -0.18) or any clinical parameters. The receiver operating curve analysis evidenced that a NT-proBNP cut-off value above 133.2 pg/ml predicted the presence of dilated right ventricular end-diastolic and end-systolic volumes over centile 95 (sensitivity 82 and 83% and specificity 93 and 79%, respectively). In conclusion, in patients with surgically corrected Tetralogy of Fallot, NT-proBNP levels correlate with right ventricular dilatation and the degree of pulmonary regurgitation. Ambulatory determination of NT-proBNP might be an easy, readily available and cost-effective alternative for MRI follow-up evaluation of these patients.
本研究的目的是评估血浆N末端B型利钠肽原（NT-proBNP）水平是否有助于作为筛查生物标志物，用于监测法洛四联症修复术后患者的右心室扩张、肺动脉反流及心力衰竭的发生。我们的单中心前瞻性观察研究纳入了43例法洛四联症矫正术后患者（平均年龄15.1岁，标准差=8岁）。数据收集包括：临床参数（心电图、胸部X线、纽约心脏协会心功能分级、距上次手术时间）、生化指标（NT-proBNP水平）和磁共振成像（MRI）值（心室容积测定、肺血流评估）。距上次手术的平均时间为13.5年（标准差=7.8年）。NT-proBNP水平（187.4 pg/ml，标准差=154.9）与右心室舒张末期容积（124.9 ml/m，标准差=31.2）（Pearson相关系数=0.19，p<0.01）及收缩末期容积（56.1 ml/m，标准差=18.8）（Pearson相关系数=0.21，p<0.01）的右心室扩张之间存在统计学显著相关性，且与肺动脉反流分数（36.5%，标准差=16，Pearson相关系数=0.12，p<0.01）也存在相关性。未发现NT-proBNP与右心室射血分数（54.6%，标准差=10.6，Pearson相关系数=-0.07）、左心室射血分数（59.9%，标准差=7.1，Pearson相关系数=-0.18）或任何临床参数之间存在显著相关性。受试者工作特征曲线分析表明，NT-proBNP临界值高于133.2 pg/ml可预测右心室舒张末期和收缩末期容积扩张超过第95百分位数（敏感性分别为82%和83%，特异性分别为93%和79%）。总之，在法洛四联症手术矫正患者中，NT-proBNP水平与右心室扩张及肺动脉反流程度相关。门诊测定NT-proBNP可能是这些患者MRI随访评估的一种简便、易得且经济有效的替代方法。
