[N端前脑钠肽在成人先天性心脏病管理中的意义——来自CSONGRAD注册研究的结果]

[The significance of N-terminal pro-B natriuretic peptide in the management of adult patients with congenital heart disease - Results from the CSONGRAD Registry].

作者信息

Ambrus Nóra, Havasi Kálmán, Berek Krisztina, Kalapos Anita, Hartyánszky István, Bogáts Gábor, Forster Tamás, Nemes Attila

机构信息

II. Belgyógyászati Klinika és Kardiológiai Központ, Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Szeged, Semmelweis u. 8., 6725.

II. Belgyógyászati Klinika és Kardiológiai Központ, Szívsebészeti Osztály, Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Szeged.

出版信息

Orv Hetil. 2018 Jan;159(4):141-148. doi: 10.1556/650.2018.30942.

DOI:10.1556/650.2018.30942

PMID:29353497

Abstract

INTRODUCTION

The prognostic role of B-type natriuretic peptide (BNP) level was confirmed in chronic heart failure and congenital heart diseases irrespective of the aetiology.

AIM

The aim of this study was to compare NT‑proBNP measured in the clinical practice and important clinical and echocardiographic parameters in patients with adult congenital heart diseases under our care.

METHOD

Data of a total of 70 patients were analysed; 34 patients had corrected tetralogy of Fallot and 19 patients had corrected transposition of the great arteries. In 17 further cases, patients with other congenital vitiums have been involved in the study. In all cases, out-patient examination was performed with electrocardiography, echocardiography and NT-proBNP measurement. The New York Heart Association (NYHA) stages of the patients were determined and the patients filled in a questionnaire regarding their quality of life.

RESULTS

Elevated NT-proBNP level resulted in a worse quality of life (visual analogue scale, VAS) and an increased right ventricular end diastolic diameter; the incidence of arrhythmia increased as well. Negative correlation was found between the NT-proBNP level and the VAS value (r = -0.45, p = 0.0001) and the left ventricular ejection fraction (LV-EF) (r = -0.67, p = <0.0001). ROC analysis showed that NT‑proBNP≥668.1 pg/ml was the cut-off value that most accurately predicted NYHA class III-IV (sensitivity 93%, specificity 63%, area under the curve 80%, p = 0.001). Similarly, NT-proBNP≥184.7 pg/ml was found to be the cut-off value most accurately predicting LV-EF below 55% (sensitivity 66%, specificity 67%, area under the curve 77%, p = 0.02).

CONCLUSIONS

NT-proBNP has a role in the evaluation of adult patients with congenital heart diseases and in determining the prognosis of these patients, and in addition to other examinations used in the follow-up of these patients, NT-proBNP may help in determining the time of reoperation or potential heart transplantation. Orv Hetil. 2018; 159(4): 141-148.

摘要

引言

无论病因如何，B型利钠肽（BNP）水平在慢性心力衰竭和先天性心脏病中都具有预后作用。

目的

本研究的目的是比较在我们照护下的成人先天性心脏病患者临床实践中测量的NT-proBNP与重要临床及超声心动图参数。

方法

共分析了70例患者的数据；34例患者为法洛四联症矫正术后，19例患者为大动脉转位矫正术后。另有17例患者为其他先天性心脏畸形，也参与了本研究。所有病例均进行了门诊检查，包括心电图、超声心动图和NT-proBNP测量。确定了患者的纽约心脏协会（NYHA）心功能分级，患者填写了关于其生活质量的问卷。

结果

NT-proBNP水平升高导致生活质量（视觉模拟评分，VAS）变差，右心室舒张末期内径增加；心律失常的发生率也增加。NT-proBNP水平与VAS值（r = -0.45，p = 0.0001）及左心室射血分数（LV-EF）（r = -0.67，p = <0.0001）之间存在负相关。ROC分析显示，NT-proBNP≥668.1 pg/ml是最准确预测NYHA III-IV级的临界值（敏感性93%，特异性63%，曲线下面积80%，p = 0.001）。同样，NT-proBNP≥184.7 pg/ml被发现是最准确预测LV-EF低于55%的临界值（敏感性66%，特异性67%，曲线下面积77%，p = 0.02）。