B-type natriuretic peptide at the early stage of univentricular circulation reflects inadequate adaptation to volume overload

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• 作者：Ryo Inuzuka ; Shunsuke Tatebe ; Sadae Wakiguchi ; Hiromichi Nakajima ; Hiroshi Ohtsu ; Konstantinos Dimopoulos ; Hiroyuki Aotsuka
• 关键词：Natriuretic peptide ; Stress ; Heart failure ; Hemodynamics ; Heart defect ; Congenital
• 刊名：International Journal of Cardiology
• 出版年：2012
• 出版时间：23 August, 2012
• 年：2012
• 卷：159
• 期：2
• 页码：88-93
• 全文大小：541 K

文摘

Background

Recent studies showed that children with univentricular heart have elevated plasma B-type natriuretic peptide (BNP) levels prior to bidirectional cavopulmonary anastomosis (BDCPA). However, it remains to be established whether BNP levels reflect the degree of hemodynamic overload and relate to long-term outcome in univentricular circulation.

Methods

Fifty one consecutive children with functionally univentricular heart prior to BDCPA were studied. All patients underwent cardiac catheterization and BNP measurement. Ventricular end-systolic wall stress (ESWS) and end-diastolic wall stress (EDWS) were calculated from cardiac catheterization data.

Results

Median age was 1.1 years and 34 % were female. Median BNP concentration was 90.4 pg/ml. Patients with high BNP (¡Ý 100 pg/ml) had higher pulmonary to systemic flow ratio (p = 0.014), a greater end-diastolic volume (p = 0.009), more severe atrioventricular valve regurgitation (p = 0.02) and lower ventricular mass to end-diastolic volume ratio (p = 0.006). BNP levels strongly related to EDWS (r = 0.75, p < 0.0001) and ESWS (r = 0.63, p < 0.0001). During median follow-up period of 3.2 years, 15 patients died and one underwent heart transplantation for refractory heart failure. On multivariate Cox regression analysis, high BNP concentration was an independent predictor of death or transplantation (HR 3.05, CI: 1.06-8.83, p = 0.04).

Conclusions

High BNP concentration at the first palliative stage towards Fontan circulation reflects high wall stress due to high volume load and insufficient ventricular hypertrophy. Moreover, high BNP levels at this stage were independently related to long-term outcome. BNP may be used as a guide to identify patients with high workload due to inadequate adaptation to hemodynamic load, who are at high risk.