Factors Associated with Serum B-Type Natriuretic Peptide in Infants with Single Ventricles

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• 作者：Ryan J. Butts (1)
  Victor Zak (2)
  Daphne Hsu (3)
  James Cnota (4)
  Steven D. Colan (5)
  David Hehir (6)
  Paul Kantor (7)
  Jami C. Levine (5)
  Renee Margossian (5)
  Marc Richmond (8)
  Anita Szwast (9)
  Derek Williams (10)
  Richard Williams (11)
  Andrew M. Atz (1)
  
• 关键词：B ; type natriuretic peptide ; BNP ; Single ; ventricle physiology ; Superior cavopulmonary connection surgery ; Angiotensin ; converting enzyme inhibition therapy ; SCPC ; Ventricular dilation
• 刊名：Pediatric Cardiology
• 出版年：2014
• 出版时间：June 2014
• 年：2014
• 卷：35
• 期：5
• 页码：879-887
• 全文大小：
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• 作者单位：Ryan J. Butts (1)
  Victor Zak (2)
  Daphne Hsu (3)
  James Cnota (4)
  Steven D. Colan (5)
  David Hehir (6)
  Paul Kantor (7)
  Jami C. Levine (5)
  Renee Margossian (5)
  Marc Richmond (8)
  Anita Szwast (9)
  Derek Williams (10)
  Richard Williams (11)
  Andrew M. Atz (1)
  
  1. Department of Pediatrics, Medical University of South Carolina, 165 Ashley Avenue, Charleston, SC, 29424, USA
  2. New England Research Institutes, Watertown, MA, USA
  3. Division of Cardiology, Children’s Hospital at Montefiore, Bronx, NY, USA
  4. Department of Cardiology, Cincinnati Children’s Hospital, Cincinnati, OH, USA
  5. Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
  6. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
  7. Department of Cardiology, Hospital for Sick Children, Toronto, ON, Canada
  8. Department of Cardiology, Children’s Hospital of New York, New York, NY, USA
  9. Department of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
  10. Department of Cardiology, Brenner Children’s Hospital, Winston-Salem, NC, USA
  11. Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
  
• ISSN：1432-1971

文摘

Data regarding the value of B-type natriuretic peptide (BNP) measurements in infants with a single-ventricle (SV) physiology are lacking. This analysis aimed to describe the BNP level changes in infants with an SV physiology before and after superior cavopulmonary connection (SCPC) surgery. Levels of BNP were measured by a core laboratory before SCPC (at 5.0?±?1.6?months) and at the age of 14?months during a multicenter trial of angiotensin-converting enzyme inhibition therapy for infants with SV. Multivariable longitudinal analysis was used to model the associations between BNP levels and three sets of grouped variables (echocardiography, catheterization, growth). Multivariable analysis was performed to assess associations with patient characteristics at both visits. Associations between BNP levels and neurodevelopmental variables were investigated at the 14?month visit because neurodevelopmental assessment was performed only at this visit. The BNP level was significantly higher before SCPC (n?=?173) than at the age of 14?months (n?=?134). The respective median levels were 80.8?pg/ml (interquartile range [IQR], 35-87?pg/ml) and 34.5?pg/ml (IQR, 17-7?pg/ml) (p?<?0.01). A BNP level higher than 100?pg/ml was present in 72 subjects (42?%) before SCPC and in 21 subjects (16?%) at the age of 14?months. In the 117 patients who had BNP measurements at both visits, the median BNP level decreased 32?pg/ml (IQR, 1-9?pg/ml) (p?<?0.01). In the longitudinal multivariable analysis, higher BNP levels were associated with a higher end-systolic volume z-score (p?=?0.01), a greater degree of atrioventricular (AV) valve regurgitation (p?<?0.01), a lower weight z-score (p?<?0.01), and a lower length z-score (p?=?0.02). In multivariable analyses, a higher BNP level at the age of 14?months was associated with arrhythmia after SCPC surgery (p?<?0.01), a prior Norwood procedure (p?<?0.01), a longer hospital stay after SCPC surgery (p?=?0.04), and a lower Bayley psychomotor developmental index (p?=?0.02). The levels of BNP decreases in infants with SV from the pre-SCPC visit to the age of 14?months. A higher BNP level is associated with increased ventricular dilation in systole, increased AV valve regurgitation, impaired growth, and poorer neurodevelopmental outcomes. Therefore, BNP level may be a useful seromarker for identifying infants with SV at risk for worse outcomes.