Niedermaier Carolin, Ono Masamichi, Klawonn Frank, Holdenrieder Stefan, Lemmer Julia, Hörer Jürgen, Ewert Peter, Palm Jonas
Technical University of Munich, German Heart Center, Department for Congenital and Pediatric Heart Surgery, Division for Congenital and Pediatric Heart Surgery, University Hospital Großhadern, Ludwig-Maximilians University, Munich, Germany.
Biostatistics, Helmholtz Center for Infection Research, Braunschweig, Germany.
Cardiol Young. 2025 Feb 14:1-10. doi: 10.1017/S1047951125000290.
Due to the high postoperative mortality, tools for an adaequate risk stratification are important to identify high-risk patients undergoing the Norwood procedure. As a marker of ventricular wall stress, NT-proBNP might be of particular interest in these children.
This study evaluated whether NT-proBNP's age-adjusted z-score ("zlog-NT-proBNP") predicts outcomes after stage I Norwood procedure.
Patients who underwent the Norwood procedure between 1 January 2011 and 31 December 2022, with perioperative NT-proBNP measurements available were enrolled. Since reference intervals of NT-proBNP are highly age-dependent, age-adjusted zlog-NT-proBNP was used. Serial zlog-NT-proBNP values were analysed to predict the occurrence of major adverse cardiovascular events after the Norwood procedure. Major adverse cardiovascular events was defined as death, resuscitation, or mechanical circulatory support. Secondary endpoints were re-operation and re-intervention for shunt.
A total of 139 patients underwent the Norwood procedure and had at least one NT-proBNP measurement available. Preoperative zlog-NT-proBNP measurements (median 3.7, interquartile range 3.1-4.19) showed no association with the occurrence of major adverse cardiovascular events or mortality. Zlog-NT-proBNP early after ICU admission (3.2, interquartile range 2.4-3.8) was predictive of mortality but showed no association with the occurrence of major adverse cardiovascular events. Zlog-NT-proBNP before ICU discharge (3.2, interquartile range 2.8-3.8) was significantly associated with the occurrence of both major adverse cardiovascular events (hazard ratio 1.83, 95% confidence interval 1.25-2.67, = 0.002) and death (hazard ratio 2.1, 95% CI 1.4-3.2, < 0.001).
High zlog-NT-proBNP levels after the Norwood surgery were strongly associated with the occurrence of major adverse cardiovascular events and death. Therefore, zlog-NT-proBNP has the potential to identify high-risk patients before life-threatening complications occur.
由于术后死亡率高，合适的风险分层工具对于识别接受诺伍德手术的高危患者很重要。作为心室壁应力的标志物，N末端B型利钠肽原（NT-proBNP）在这些儿童中可能特别受关注。
本研究评估了NT-proBNP的年龄校正z评分（“zlog-NT-proBNP”）是否能预测I期诺伍德手术后的结局。
纳入2011年1月1日至2022年12月31日期间接受诺伍德手术且有围手术期NT-proBNP测量值的患者。由于NT-proBNP的参考区间高度依赖年龄，因此使用年龄校正的zlog-NT-proBNP。分析zlog-NT-proBNP的系列值以预测诺伍德手术后主要不良心血管事件的发生。主要不良心血管事件定义为死亡、复苏或机械循环支持。次要终点是再次手术和分流的再次干预。
共有139例患者接受了诺伍德手术且至少有一次NT-proBNP测量值。术前zlog-NT-proBNP测量值（中位数3.7，四分位间距3.1 - 4.19）与主要不良心血管事件的发生或死亡率无关。重症监护病房（ICU）入院后早期的zlog-NT-proBNP（3.2，四分位间距2.4 - 3.8）可预测死亡率，但与主要不良心血管事件的发生无关。ICU出院前的zlog-NT-proBNP（3.2，四分位间距2.8 - 3.8）与主要不良心血管事件（风险比1.83，95%置信区间1.25 - 2.67，P = 0.002）和死亡（风险比2.1，95%置信区间1.4 - 3.2，P < 0.001）的发生均显著相关。
诺伍德手术后高zlog-NT-proBNP水平与主要不良心血管事件和死亡的发生密切相关。因此，zlog-NT-proBNP有潜力在危及生命的并发症发生前识别高危患者。
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