Ghelani Sunil J, Opotowsky Alexander R, Harrild David M, Powell Andrew J, Azcue Nina, Ahmad Sidra, Clair Nicole St, Bradwin Gary, Rathod Rahul H
Department of Cardiology; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Department of Cardiology; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Am J Cardiol. 2022 Jan 1;162:177-183. doi: 10.1016/j.amjcard.2021.08.063.
Several circulating biomarkers have been found to play a role in the surveillance and risk stratification of heart failure without congenital heart disease, but these have not been widely studied in patients with single ventricles palliated with a Fontan operation. Imaging predictors of worse outcomes in this population include ventricular dilation and dysfunction. Patients who weighed >30 kg with a Fontan circulation referred for cardiac magnetic resonance imaging were invited to participate in the study. Blood and urine samples were obtained at the time of imaging and multiple conventional and novel biomarkers were measured. A total of 82 patients with a median age of 18 years were enrolled. Among the novel biomarkers, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T had the strongest correlation with ventricular dilation and dysfunction. NT-ProBNP >100 pg/ml has a sensitivity of 91% for the detection of significant ventricular dilation (end-diastolic volume >120 ml/body surface area) and 82% for detection of ejection fraction <50%. The urinary neutrophil gelatinase-associated lipocalin-2 to creatinine ratio correlated with ejection fraction and estimated glomerular filteration rate. In conclusion, abnormalities in biomarkers of heart failure are common in ambulatory, largely asymptomatic patients with Fontan circulation. NT-ProBNP may serve as a sensitive marker for the identification of patients with significant ventricular dilation or dysfunction. Further work is needed to understand how these easily measured circulating biomarkers may be integrated into clinical care.
已发现几种循环生物标志物在无先天性心脏病的心力衰竭监测和风险分层中发挥作用，但在接受Fontan手术姑息治疗的单心室患者中，这些生物标志物尚未得到广泛研究。该人群中预后较差的影像学预测指标包括心室扩张和功能障碍。邀请体重>30 kg且有Fontan循环并接受心脏磁共振成像检查的心衰患者参与本研究。在成像时采集血液和尿液样本，并检测多种传统和新型生物标志物。共纳入82例患者，中位年龄为18岁。在新型生物标志物中，N末端B型利钠肽原（NT-proBNP）和高敏肌钙蛋白T与心室扩张和功能障碍的相关性最强。NT-ProBNP>100 pg/ml检测显著心室扩张（舒张末期容积>120 ml/体表面积）的灵敏度为91%，检测射血分数<50%的灵敏度为82%。尿中性粒细胞明胶酶相关脂质运载蛋白-2与肌酐比值与射血分数和估计肾小球滤过率相关。总之，心力衰竭生物标志物异常在接受Fontan循环的门诊、大多无症状患者中很常见。NT-ProBNP可作为识别有显著心室扩张或功能障碍患者的敏感标志物。需要进一步开展工作以了解这些易于检测的循环生物标志物如何整合到临床治疗中。
