Jamei Khosroshahi Ahmad, Molaei Akbar, Samadi Mahmoud, Eskandartash Elnaz
Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran.
Pediatric Health Reserch Center, Tabriz University of Medical Science, Tabriz, Iran.
J Cardiovasc Thorac Res. 2019;11(1):68-71. doi: 10.15171/jcvtr.2019.11. Epub 2019 Feb 16.
Natriuretic peptides such as brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP) and pro-BNP are secreted in response to atrial and/or ventricular stretch. Left to right shunts such as ventricular septal defect (VSD), atrial septal defect (ASD), and patent ductus arteriosus (PDA), are treated medically or surgically. We aimed to evaluate whether the serum level of pro-BNP would be useful to measure the amount of the shunt. In this cross sectional study, 60 infants and children, in whom physical examinations approved heart murmur, and had undergone echocardiography by which VSD, ASD, or PDA had been proven, were included in the study. The relationship between serum BNP levels and severity of shunt (Qp/Qs) based on echocardiographic and hemodynamic evaluations, was studied. There was a significant relationship between serum level of pro-BNP and the amount of the shunt in the patients with VSD, ASD, and PDA (=0.01). A positive correlation was seen between pro-BNP serum level and Qp/Qs ratio. The mean ± SE serum level of pro-BNP in patients with Qp/Qs ratio of less than 1.5, equal to 1.5-2, and more than 2 was 30.83±2.4, 217.88±44.6, and 217.13±51.8, respectively showing a significant relationship (=0.0001). The cut-off point of pro-BNP demonstrating a Qp/Qs ratio more than 1.5 was measured at the level of 40.36 pg/mL, with a sensitivity and specificity of 92% and 79%, respectively. Based on our study, the cut-off point of 40.36 pg/mL or more for pro-BNP, showing a Qp/Qs ratio more than 1.5, can be considered as an indication for interventional procedures.
利钠肽，如脑利钠肽（BNP）、心房利钠肽（ANP）和前脑利钠肽（pro-BNP），是对心房和/或心室扩张作出反应而分泌的。室间隔缺损（VSD）、房间隔缺损（ASD）和动脉导管未闭（PDA）等左向右分流，可通过内科或外科方法治疗。我们旨在评估前脑利钠肽的血清水平是否有助于测量分流量。在这项横断面研究中，纳入了60名婴儿和儿童，他们经体格检查证实有心脏杂音，并接受了超声心动图检查，证实患有室间隔缺损、房间隔缺损或动脉导管未闭。研究了基于超声心动图和血流动力学评估的血清BNP水平与分流严重程度（Qp/Qs）之间的关系。在患有室间隔缺损、房间隔缺损和动脉导管未闭的患者中，前脑利钠肽的血清水平与分流量之间存在显著关系（P=0.01）。在前脑利钠肽血清水平与Qp/Qs比值之间观察到正相关。Qp/Qs比值小于1.5、等于1.5 - 2和大于2的患者中，前脑利钠肽的平均±标准误血清水平分别为30.83±2.4、217.88±44.6和217.13±51.8，显示出显著关系（P=0.0001）。显示Qp/Qs比值大于1.5的前脑利钠肽的截断点测量值为40.36 pg/mL，敏感性和特异性分别为92%和79%。基于我们的研究，前脑利钠肽40.36 pg/mL及以上的截断点，显示Qp/Qs比值大于1.5，可被视为介入治疗的指征。
