Clinical utility of the plasma brain natriuretic peptide level in monitoring tetralogy of fallot patients over the long term after initial intracardiac repair: considerations for pulmonary valve replacement.
Clinical utility of the plasma brain natriuretic peptide level in monitoring tetralogy of fallot patients over the long term after initial intracardiac repair: considerations for pulmonary valve replacement.
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血浆脑钠尿肽水平在初次心内修复后长期监测法洛四联症患者中的临床效用：肺动脉瓣置换术的考虑因素。
DOI：
10.1007/s00246-014-1075-3
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发表时间：
2015
影响因子：
1.6
通讯作者：
Ishii M
中科院分区：
文献类型：
--
作者：
Kitagawa A;Oka N;Kimura S;Ando H;Honda T;Takanashi M;Mineo E;Miyaji K;Ishii M
目前，临床医生遇到越来越多的患者在法洛四联症（TOF）修复后的长期时间内出现肺动脉瓣返流（PR）或右心室（RV）功能障碍。本研究的目的是评价血浆脑钠肽（BNP）水平的临床应用，并考虑手术指征和肺动脉瓣置换术（PVR）的时机。我们检查了33例在北里大学医院接受TOF修复术的患者（21例男性，12例女性，平均年龄14.5 ± 2.8岁）。所有患者均采用超声心动图和血液采样进行评估。初次修复时的平均年龄为1.3 ± 0.7岁。中重度PR患者的血浆BNP水平显著高于轻度PR患者（平均37.5 ± 33.1 vs 17.3 ± 6.6 pg/ml，p= 0.013）。有心脏症状的患者的平均血浆BNP水平高于无任何症状的患者（71.4 ± 46.1 vs. 25.0 ± 14.0 pg/ml，p= 0.005）。PVR后平均BNP水平显著降低（71.3 ± 46.1-26.1 ± 13.2 pg/ml，p= 0.009），血浆BNP水平与RV舒张末期压呈正相关（r= 0.851;p= 0.008）。考虑PVR的最佳BNP临界值为32.15 pg/ml（敏感性，85.7%;特异性，83.3%）。血浆BNP水平可能成为一个有用的诊断工具，考虑在TOF修复后的长期PVR的适应证和最佳时机。
Clinicians are currently encountering an increasing number of patients in the long-term period after tetralogy of Fallot (TOF) repair presenting with pulmonary valve regurgitation (PR) or right ventricular (RV) dysfunction. The purpose of this study was to evaluate the clinical utility of the plasma brain natriuretic peptide (BNP) level and consider surgical indications and timing of pulmonary valve replacement (PVR). We examined 33 patients (21 males, 12 females, mean age 14.5 ± 2.8 years) who underwent TOF repair at Kitasato University Hospital. All patients were evaluated using echocardiography and blood sampling. The mean age at the time of initial repair was 1.3 ± 0.7 years. The patients with moderate–severe PR exhibited significantly higher plasma BNP levels than the patients with trivial–mild PR (mean 37.5 ± 33.1 vs. 17.3 ± 6.6 pg/ml,p= 0.013). The mean plasma BNP level with cardiac symptoms was higher than that observed in the patients without any symptoms (71.4 ± 46.1 vs. 25.0 ± 14.0 pg/ml,p= 0.005). The mean BNP level was significantly decreased after PVR (71.3 ± 46.1–26.1 ± 13.2 pg/ml,p= 0.009), and the plasma BNP level was found to be positively correlated with the RV end-diastolic pressure (r= 0.851;p= 0.008). The optimal BNP cut-off value for considering PVR was 32.15 pg/ml (sensitivity, 85.7 %; specificity, 83.3 %). The plasma BNP level may become a useful diagnostic tool for considering the indications and optimal timing of PVR over the long term after TOF repair.