Department of Pediatrics.
Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
Am J Cardiol. 2023 Sep 15;203:23-28. doi: 10.1016/j.amjcard.2023.06.112. Epub 2023 Jul 21.
Angiopoietin-2 is associated with chronic inflammation and angiogenesis, but its activity after Fontan operation in pediatric patients remains uncertain. We compared serum angiopoietin-2 levels in pediatric patients after Fontan operation versus those with congenital heart disease as a control group. A total of 185 patients (median age 7 [3 to 12] years, 106 males) were included, consisting of 140 in the Fontan group and 45 in the control group. Serum angiopoietin-2 levels were significantly higher in the Fontan group (7,670 vs 2,351 pg/ml, p <0.001). In the Fontan group, a serum angiopoietin-2 level ≥3.9 of common logarithm was an independent risk factor for death or Fontan-related adverse events with an adjusted hazard ratio of 6.25 (95% confidence interval 1.64 to 23.9, p = 0.007). In preoperative variables, desaturation was independently associated with increased serum angiopoietin-2 levels after Fontan operation (p = 0.047). In conclusion, serum angiopoietin-2 levels were elevated in the pediatric phase after Fontan operation. In Fontan patients, a higher serum angiopoietin-2 level was an independent risk factor for death or Fontan-related adverse events. The clinical implication of measuring and monitoring serum angiopoietin-2 levels in this cohort requires further investigation.
血管生成素-2 与慢性炎症和血管生成有关，但在儿科患者行 Fontan 手术后其活性尚不确定。我们比较了 Fontan 手术后儿科患者与先天性心脏病对照组患者的血清血管生成素-2 水平。共纳入 185 例患者（中位年龄 7 [3 至 12] 岁，106 例男性），其中 140 例在 Fontan 组，45 例在对照组。Fontan 组患者血清血管生成素-2 水平明显更高（7670 比 2351 pg/ml，p <0.001）。在 Fontan 组中，血清血管生成素-2 水平≥3.9 对数为死亡或 Fontan 相关不良事件的独立危险因素，调整后的危险比为 6.25（95%置信区间为 1.64 至 23.9，p = 0.007）。在术前变量中，饱和度下降与 Fontan 手术后血清血管生成素-2 水平升高独立相关（p = 0.047）。总之，Fontan 手术后的儿科阶段血清血管生成素-2 水平升高。在 Fontan 患者中，较高的血清血管生成素-2 水平是死亡或 Fontan 相关不良事件的独立危险因素。在该队列中测量和监测血清血管生成素-2 水平的临床意义需要进一步研究。
