Usefulness of B-Type Natriuretic Peptide and N-Terminal Pro-B-Type Natriuretic Peptide as Biomarkers for Heart Failure in Young Children With Single Ventricle Congenital Heart Disease
Usefulness of B-Type Natriuretic Peptide and N-Terminal Pro-B-Type Natriuretic Peptide as Biomarkers for Heart Failure in Young Children With Single Ventricle Congenital Heart Disease
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DOI：
10.1016/j.amjcard.2011.10.049
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发表时间：
2012-03-15
影响因子：
2.8
通讯作者：
Bernstein, Harold S.
中科院分区：
文献类型：
--
作者：
Lowenthal, Alexander;Camacho, Benjamin Villareal;Bernstein, Harold S.
具有单心室 (SV) 生理学特征的儿童心室做功增加，并且存在心力衰竭 (HF) 的风险。然而，心力衰竭的诊断尤其困难，因为在该队列中很少有客观的心力衰竭指标得到验证。我们之前已经证明，血浆 B 型利钠肽 (BNP) 水平对于检测小型异质 SV 队列中的心力衰竭具有敏感性和特异性。本研究的目的是确定 SV 形态和姑息治疗阶段对 BNP 和 HF 之间相关性的影响。我们还研究了 N 末端 BNP 前体 (NT-proBNP)（一种更稳定的 BNP 前加工产物）作为这些患者心力衰竭生物标志物的效用。对 1 个月至 7 岁的 SV 儿童进行了横断面观察研究。心力衰竭的存在定义为 Ross 评分 > 2。使用逻辑回归分析和受试者工作特征曲线评估 BNP 或 NT-proBNP 与心力衰竭的关联。在 71 名儿童中，22 名 (31%) 患有临床心力衰竭。 BNP 倍增与 HF 的优势比 2.20（95% 置信区间 1.36 至 3.55，p = 0.001）相关，c 统计量 > 75%，检测阈值 >= 45 pg/ml。当患者按右心室形态或姑息手术阶段进行分层时，该阈值得以保留。同样，NT-proBNP 的倍增与 HF 的优势比 1.92 相关（95% 置信区间 1.17 至 3.14，p = 0.009）。与SNP相比，NT-proBNP预测心力衰竭的阈值随着姑息治疗的阶段而降低。总之，血浆 BNP 和 NT-proBNP 是患有 SV 生理学的幼儿（特别是具有右心室形态的幼儿）临床心力衰竭的可靠测试，无论姑息治疗处于哪个阶段。 (C) 2012 Elsevier Inc. 保留所有权利。 (Am J Cardiol 2012；109:866-872)
Children with single ventricle (SV) physiology have increased ventricular work and are at risk of heart failure (HF). However, a HF diagnosis is especially difficult, because few objective measures of HF have been validated in this cohort. We have previously shown that plasma B-type natriuretic peptide (BNP) levels are sensitive and specific for detecting HF in a small, heterogeneous SV cohort. The aim of the present study was to define the effect of SV morphology and stage of palliation on the correlation between BNP and HF. We also examined the utility of N-terminal pro-BNP (NT-proBNP), a more stable product of pre-BNP processing, as a biomarker of HF in these patients. A cross-sectional observational study of SV children aged 1 month to 7 years was conducted. The presence of HF was defined as a Ross score > 2. The association of BNP or NT-proBNP with HF was assessed using logistic regression analysis and receiver operating characteristic curves. Of the 71 included children, 22 (31%) had clinical HF. A doubling of BNP was associated with an odds ratio for HF of 2.20 (95% confidence interval 1.36 to 3.55, p = 0.001) with a c-statistic > 75%, yielding a detection threshold of >= 45 pg/ml. This threshold was preserved when patients were stratified by the right ventricular morphology or stage of surgical palliation. Similarly, a doubling of NT-proBNP was associated with an odds ratio for HF of 1.92 (95% confidence interval 1.17 to 3.14, p = 0.009). In contrast to SNP, the threshold value of NT-proBNP for predicting HF decreased with the stage of palliation. In conclusion, plasma BNP and NT-proBNP are reliable tests for clinical HF in young children with SV physiology, specifically those with right ventricular morphology, regardless of the stage of palliation. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;109:866-872)