Leczycki Patryk, Banach Maciej, Maciejewski Marek, Bielecka-Dabrowa Agata
Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute, Łodź, Poland.
Department of Preventive Cardiology and Lipidology, Medical University of Lodz, Łodź, Poland.
Front Cardiovasc Med. 2022 Feb 24;9:692815. doi: 10.3389/fcvm.2022.692815. eCollection 2022.
In recent decades the number of adults with congenital heart diseases (ACHD) has increased significantly. This entails the need for scrupulous evaluation of the current condition of these patients. The ACHD population is one of the most challenging in contemporary medicine, especially as well-known scales such as the NYHA classification have very limited application. At the moment, there is a lack of universal parameters or scales on the basis of which we can easily capture the moment of deterioration of our ACHD patients' condition. Hence it is crucial to identify factors that are widely available, cheap and easy to use. There are studies showing more and more potential prognostic factors that may be of use in clinical practice: thorough assessment with echocardiography and magnetic resonance imaging (e.g., anatomy, ventricular function, longitudinal strain, shunt lesions, valvular defects, pericardial effusion, and pulmonary hypertension), cardiopulmonary exercise testing (e.g., peak oxygen uptake, ventilatory efficiency, chronotropic incompetence, and saturation) and biomarkers (e.g., N-terminal pro-brain type natriuretic peptide, growth-differentiation factor 15, high-sensitivity troponin T, red cell distribution width, galectin-3, angiopoietin-2, asymmetrical dimethylarginine, and high-sensitivity C-reactive protein). Some of them are very promising, but more research is needed to create a specific panel on the basis of which we will be able to assess patients with specific congenital heart diseases.
近几十年来，患有先天性心脏病的成年人（ACHD）数量显著增加。这就需要对这些患者的当前状况进行细致评估。ACHD人群是当代医学中最具挑战性的群体之一，尤其是像纽约心脏协会（NYHA）分级这样的知名量表应用非常有限。目前，缺乏通用的参数或量表，基于这些我们能够轻松捕捉ACHD患者病情恶化的时刻。因此，识别广泛可用、成本低廉且易于使用的因素至关重要。有研究表明越来越多潜在的预后因素可能在临床实践中有用：通过超声心动图和磁共振成像进行全面评估（例如，解剖结构、心室功能、纵向应变、分流病变、瓣膜缺陷、心包积液和肺动脉高压）、心肺运动测试（例如，峰值摄氧量、通气效率、变时性功能不全和饱和度）以及生物标志物（例如，N末端脑钠肽前体、生长分化因子15、高敏肌钙蛋白T、红细胞分布宽度、半乳糖凝集素-3、血管生成素-2、不对称二甲基精氨酸和高敏C反应蛋白）。其中一些非常有前景，但需要更多研究来创建一个特定的指标组合，基于此我们将能够评估患有特定先天性心脏病的患者。
