Echocardiographic Parameters During and Beyond Onset of Kawasaki Disease Correlate with Onset Serum N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP)
Echocardiographic Parameters During and Beyond Onset of Kawasaki Disease Correlate with Onset Serum N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP)
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DOI：
10.1007/s00246-020-02340-z
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发表时间：
2020-06-01
影响因子：
1.6
通讯作者：
Dahdah, Nagib
中科院分区：
文献类型：
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作者：
Desjardins, Laurent;Dionne, Audrey;Dahdah, Nagib
由心肌细胞产生的N-末端脑钠肽前体（NT-proBNP）在急性川崎病（KD）中有几种报道的效用和关联。本研究的目的是检查KD诊断时血清NT-proBNP值与心脏收缩、舒张功能和心电图变化、疾病发作时和第一年随访期间的关系。2007年3月至2014年7月期间，127名儿童被诊断为KD，平均诊断年龄为3.5 ± 2.9岁。冠状动脉最大评分为2.6 ± 2.8（范围-0.6至+18.9），5/122例（4.1%）有巨大动脉瘤。经t检验校正的NT-proBNP为2.6 +/-1.6z评分，78/122（63.9%）> 2.0。发病NT-proBNPz评分与C反应蛋白（CRP）血清水平之间存在逐渐增强的相关性（斜率+0.49，p < 0.001）。NT-proBNP评分与左室质量指数（斜率+1.86，p = 0.02）、左室舒张功能参数E/e '比值（斜率+0.31，p = 0.04）呈递增相关，与年龄校正的左室缩短分数（SF）呈递减相关（-0.63，p = 0.02）。SFz评分越低、左室重量指数和E/e '比值越高，NT-proBNP评分越高，但与CRP水平无关。在发病后2-3个月内，收缩功能障碍消退。心电图参数变化与LV缩短分数降低相关，但与NT-proBNP无关。发病时NT-proBNP升高的KD患者存在亚临床心肌受累，即使在没有冠状动脉受累的情况下，也可能从随访和持续评估中获益。
The N-terminal proBNP (NT-proBNP), produced by cardiomyocytes, has several reported utilities and associations in acute Kawasaki disease (KD). The objective of this study is to examine the relationship between serum values of NT-proBNP at time of KD diagnosis with cardiac systolic, diastolic function and electrocardiographic changes, at onset of the disease and during the first year of follow-up. KD was diagnosed in 127 children between March 2007 and July 2014, mean diagnostic age 3.5 +/- 2.9 years. Coronary artery maximumzscore was 2.6 +/- 2.8 (range - 0.6 to + 18.9), with giant aneurysm in 5/122 (4.1%). Age-adjusted NT-proBNP was 2.6 +/- 1.6zscore, 78/122 (63.9%) > 2.0. There was a crescendo correlation between onset NT-proBNPzscore and C-Reactive protein (CRP) serum levels (slope + 0.49,p < 0.001). There was a crescendo correlation between NT-proBNPzscore and indexed left ventricular (LV) mass (slope + 1.86,p = 0.02), LV diastolic function parameterE/e ' ratio (slope + 0.31,p = 0.04) and a decrescendo correlation with age-adjusted LV shortening fraction (SF) (- 0.63,p = 0.02). Lower SFzscore, higher left ventricular mass index andE/e ' ratio were associated with higher NT-proBNPzscore, but without correlation with CRP levels. Within 2-3 months from the onset of the disease, there was a resolution of the systolic dysfunction. Electrocardiographic parameter changes were associated with decreased LV shortening fraction but not with NT-proBNP. KD patients with elevated NT-proBNP at onset have sub-clinical myocardial involvement and might benefit from follow-up and continued evaluation, even in the absence of coronary artery involvement.