Ozturk Tasar Nurdan, Kosger Pelin, Uzuner Nevzat, Ucar Birsen
Clinic of Pediatrics, Afyonkarahisar Sinanpasa State Hospital, Afyonkarahisar, Turkey.
Department of Pediatric Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
Congenit Heart Dis. 2018 Nov;13(6):1038-1044. doi: 10.1111/chd.12678. Epub 2018 Oct 2.
We aimed to investigate the effect of ventricular septal defect (VSD) and heart failure on cerebral blood flow (CBF) in children, whether heart failure treatment improves CBF, and if there is any relationship between CBF and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level.
Forty children with VSD (13 with heart failure) aged between 1 and 36 months were studied. The control group comprised 25 healthy children in the same age group. Maximum, minimum, and mean blood flow velocities and pulsatility indices of the right and left middle cerebral arteries were assessed using transcranial Doppler ultrasonography. Measurements of CBF and serum NT-proBNP levels were repeated in patients with heart failure a month post-heart failure treatment initiation. The groups were also compared in terms of defect diameters, cardiac structural changes, left ventricular systolic function, and findings related to pulmonary hypertension determined by echocardiography. Correlations between echocardiographic measurements and CBF parameters were analyzed.
Although no significant difference was found between patient and control groups for CBF, right and left maximum CBF velocities significantly increased posttreatment in patients with heart failure (P = .04 and P = .01, respectively). Serum NT-proBNP levels in children with VSD associated with heart failure were significantly higher than those in children with VSD alone (P = .04) or in healthy children (P < .001). NT-proBNP levels were negatively correlated with right and left maximum CBF velocities (r = -0.39, P = .013 and r = -0.32, P = .043, respectively).
Although no significant difference was found in CBF velocity among the study groups, increase in the CBF velocity post heart failure treatment and negative correlations between CBF velocity and both the VSD diameter and NT-proBNP levels indicate that the hemodynamic status due to VSD associated with heart failure has an effect on CBF.
我们旨在研究室间隔缺损（VSD）和心力衰竭对儿童脑血流量（CBF）的影响，心力衰竭治疗是否能改善CBF，以及CBF与血清N末端脑钠肽前体（NT-proBNP）水平之间是否存在关联。
对40例年龄在1至36个月的VSD患儿（其中13例合并心力衰竭）进行研究。对照组包括25名同年龄组的健康儿童。使用经颅多普勒超声评估右侧和左侧大脑中动脉的最大、最小和平均血流速度以及搏动指数。心力衰竭治疗开始后1个月，对心力衰竭患者重复测量CBF和血清NT-proBNP水平。还通过超声心动图比较了各组在缺损直径、心脏结构变化、左心室收缩功能以及与肺动脉高压相关的检查结果。分析超声心动图测量值与CBF参数之间的相关性。
虽然患者组和对照组之间的CBF无显著差异，但心力衰竭患者治疗后右侧和左侧最大CBF速度显著增加（分别为P = 0.04和P = 0.01）。合并心力衰竭的VSD患儿血清NT-proBNP水平显著高于单纯VSD患儿（P = 0.04）或健康儿童（P < 0.001）。NT-proBNP水平与右侧和左侧最大CBF速度呈负相关（分别为r = -0.39，P = 0.013和r = -0.32，P = 0.043）。
虽然研究组之间的CBF速度无显著差异，但心力衰竭治疗后CBF速度增加以及CBF速度与VSD直径和NT-proBNP水平均呈负相关，表明合并心力衰竭的VSD所导致的血流动力学状态对CBF有影响。
