Wang Jian, Zhou Yue, Wang Qingjie, Du Bowen, Wu Yurong, Chen Qian, Zhang Xi, Lu Yanan, Chen Sun, Sun Kun
Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Front Cardiovasc Med. 2020 Nov 12;7:581848. doi: 10.3389/fcvm.2020.581848. eCollection 2020.
Assessing right ventricular overload in children is challenging. We conducted this study involving children with pulmonary valvular stenosis (PS) or pulmonary atresia with intact ventricular septum (PA/IVS) to evaluate the potential of a new endogenous ligand of apelin receptor, Elabela (ELA), as a potential biomarker for right heart overload. In this prospective cohort study, a total of 118 congenital heart diseases patients with right ventricle outflow tract obstruction were recruited from 2018 to 2019. Among them, 44 isolated PS and 7 PA/IVS patients were selected. Their venous blood was collected, and all patients underwent an echocardiographic examination. Among them, post-operative blood was collected from 24 patients with PS after percutaneous balloon pulmonary valvuloplasty. The plasma ELA concentration was measured using enzyme-linked immunosorbent assay. The ELA was significantly associated with the peak transvalvular pulmonary gradient ( = -0.62; = 0.02), thus reflecting the severity of PS or PA/IVS. The ELA significantly increased at 3 days after intervention, when mechanical obstruction of the right outflow tract was relieved. Based on the receiver-operator characteristic curve results, ELA could be a risk factor for duct dependence in patients with critical PS or PA/IVS who are younger than 6 months (AUC: 0.82). ELA concentration and severity of PS or PA/IVS had a significant negative correlation, indicating that ELA might be a novel biomarker for right ventricular afterload and reflect the immediate pressure changes in the right heart. Furthermore, ELA could predict duct-dependency in PS and PA/IVS patients, as valuable as classical echocardiographic indexes.
评估儿童右心室超负荷具有挑战性。我们开展了这项针对患有肺动脉瓣狭窄(PS)或室间隔完整的肺动脉闭锁(PA/IVS)儿童的研究,以评估一种新的apelin受体内源性配体——埃拉贝拉(ELA)作为右心超负荷潜在生物标志物的可能性。在这项前瞻性队列研究中,2018年至2019年共招募了118例患有右心室流出道梗阻的先天性心脏病患者。其中,选取了44例孤立性PS患者和7例PA/IVS患者。采集了他们的静脉血,所有患者均接受了超声心动图检查。其中,24例PS患者在经皮球囊肺动脉瓣成形术后采集了术后血液。采用酶联免疫吸附测定法测量血浆ELA浓度。ELA与跨瓣膜肺动脉峰值梯度显著相关( = -0.62; = 0.02),从而反映了PS或PA/IVS的严重程度。在干预后3天,当右流出道的机械性梗阻解除时,ELA显著升高。根据受试者工作特征曲线结果,ELA可能是6个月以下重症PS或PA/IVS患者导管依赖的危险因素(AUC:0.82)。ELA浓度与PS或PA/IVS的严重程度呈显著负相关,表明ELA可能是右心室后负荷的一种新型生物标志物,并反映右心的即时压力变化。此外,ELA可以预测PS和PA/IVS患者的导管依赖性,与经典超声心动图指标一样有价值。