Palm Jonas, Niedermaier Carolin, Holdenrieder Stefan, Hoffmann Georg, Klawonn Frank, Hörer Jürgen, Ono Masamichi, Ewert Peter
Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center, TUM University Hospital, Munich, Germany.
Department for Congenital and Pediatric Heart Surgery, German Heart Center, TUM University Hospital, Munich, Germany.
Pediatr Cardiol. 2025 Jun 3. doi: 10.1007/s00246-025-03898-2.
As a marker of cardiac wall stress, NT-proBNP offers high prognostic and diagnostic potential in patients with a functional single ventricle (fSV). Its levels depend on both age and stage of palliation. However, the impact of systemic ventricular morphology on this biomarker remains unclear. Children undergoing staged palliation, i.e. systemic-to-pulmonary shunt (SPS), ductal stenting (DS) and/or pulmonary artery banding (PAB) as stage 1, bidirectional cavopulmonary shunt (BCPS) as stage 2 or extracardiac total cavopulmonary connection (TCPC) as stage 3 at our institution between 2011 and 2023 were identified. Those, who had NT-proBNP determined at most 7 days before intervention or surgery were included. Furthermore, patients at least 6 months after TCPC with ambulatory measured NT-proBNP were enrolled. NT-proBNP levels were evaluated using its age-adjusted z-score ("zlog-NT-proBNP"), allowing comparison irrespective of the distinctive physiological decline with age. Overall, 618 children met the eligibility criteria. Thereof, 356 patients had a systemic right ventricle (SRV) and 262 a systemic left ventricle (SLV). At each stage of palliation, age-adjusted zlog-NT-proBNP was significantly higher in patients with an SRV compared to an SLV: before SPS/DS/PAB (median 3.43 vs 2.62, p < 0.001); before BCPS (median 3.33 vs 2.04, p < 0.001); before TCPC (median 1.50 vs 0.66, p < 0.001); and after TCPC (median 1.62 vs 0.81, p < 0.001). Systemic ventricular morphology highly affects (zlog-)NT-proBNP levels in fSV patients at each stage of palliation. When interpreting NT-proBNP levels in these patients, clinicians and future studies should take into account that children with an SRV reveal higher NT-proBNP levels than those with an SLV.
作为心脏壁应力的标志物，N末端B型利钠肽原（NT-proBNP）在功能性单心室（fSV）患者中具有较高的预后和诊断潜力。其水平取决于年龄和姑息治疗阶段。然而，体循环心室形态对这种生物标志物的影响仍不清楚。我们确定了2011年至2023年期间在我院接受分期姑息治疗的儿童，即作为第一阶段的体肺分流术（SPS）、导管支架置入术（DS）和/或肺动脉环扎术（PAB），作为第二阶段的双向腔肺分流术（BCPS）或作为第三阶段的心外全腔肺连接术（TCPC）。纳入那些在干预或手术前最多7天测定NT-proBNP的患者。此外，纳入了在TCPC术后至少6个月进行动态测量NT-proBNP的患者。使用年龄校正的z评分（“zlog-NT-proBNP”）评估NT-proBNP水平，从而可以不考虑随年龄独特的生理下降进行比较。总体而言，618名儿童符合纳入标准。其中，356例患者为体循环右心室（SRV），262例为体循环左心室（SLV）。在姑息治疗的每个阶段，SRV患者的年龄校正zlog-NT-proBNP均显著高于SLV患者：在SPS/DS/PAB之前（中位数3.43对2.62，p<0.001）；在BCPS之前（中位数3.33对2.04，p<0.001）；在TCPC之前（中位数1.50对0.66，p<0.001）；以及在TCPC之后（中位数1.62对0.81，p<0.001）。体循环心室形态在fSV患者姑息治疗的每个阶段都对（zlog-）NT-proBNP水平有高度影响。在解释这些患者的NT-proBNP水平时，临床医生和未来的研究应考虑到SRV儿童的NT-proBNP水平高于SLV儿童。
