Quantification of ventricular stress in univentricular hearts during early childhood using age-independent zlog-NT-proBNP.

Autor: Palm J; Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center of the Technical University Munich, Germany. Electronic address: palmj@dhm.mhn.de., Ono M; Department for Congenital and Pediatric Heart Surgery, German Heart Center of the Technical University Munich, Division for Congenital and Pediatric Heart Surgery, University Hospital Großhadern, Ludwig-Maximilians University, Munich, Germany., Niedermaier C; Department for Congenital and Pediatric Heart Surgery, German Heart Center of the Technical University Munich, Division for Congenital and Pediatric Heart Surgery, University Hospital Großhadern, Ludwig-Maximilians University, Munich, Germany., Hörer J; Department for Congenital and Pediatric Heart Surgery, German Heart Center of the Technical University Munich, Division for Congenital and Pediatric Heart Surgery, University Hospital Großhadern, Ludwig-Maximilians University, Munich, Germany., Hoffmann G; Institute of Laboratory Medicine, German Heart Center of the Technical University Munich, Germany., Holdenrieder S; Institute of Laboratory Medicine, German Heart Center of the Technical University Munich, Germany., Klawonn F; Biostatistics, Helmholtz Center for Infection Research, Braunschweig, Germany; Institute for Information Engineering, Ostfalia University of Applied Sciences, Wolfenbuttel, Germany., Ewert P; Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center of the Technical University Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Germany.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2024 Jul 01; Vol. 406, pp. 131983. Date of Electronic Publication: 2024 Mar 22.
DOI: 10.1016/j.ijcard.2024.131983
Abstrakt: Background: Children with univentricular hearts (UVH) undergo up to three palliative surgical procedures to achieve complete circulatory separation (Fontan circulation). As a marker of cardiac wall stress, NT-proBNP is a promising tool to assess systemic ventricular load in these patients. However, different reference intervals (RI) apply to each stage, as NT-proBNP is highly age-dependent.
Methods: Children undergoing systemic-to-pulmonary (SP) shunt placement (stage 1), bidirectional cavopulmonary shunt (BCPS, stage 2) or total cavopulmonary connection (TCPC, stage 3) between 2011 and 2021 with NT-proBNP measurement within 7 days before surgery were included. Furthermore, outpatients after TCPC with NT-proBNP measurement were enrolled. Biomarker levels were evaluated using its age-adjusted z-score ("zlog-NT-proBNP"; age-independent RI, -1.96 to +1.96), allowing comparison between different stages and revealing changes in systemic ventricular load independent of the marked physiological decline in RI with age.
Results: Overall, 289 children (227 before, 62 after TCPC) met the eligibility criteria. Median time between blood sampling and surgery (SP shunt/BCPS/TCPC) was 2 [1-3] days and 3.2 [2.0-4.5] years after TCPC. Age-adjusted zlog-NT-proBNP levels were 3.47 [2.79-3.93] in children with native UVH (before SP shunt), 3.10 [1.89-3.58] at stage 1 (before BCPS), 1.08 [0.51-1.88] at stage 2 (before TCPC), and 1.09 [0.72-1.75] at stage 3 (after TCPC/Fontan completion). Consequently, BCPS revealed the strongest decrease (median - 2.02 logarithmized standard deviations, p < 0.001).
Conclusions: In children with UVH undergoing staged Fontan palliation, zlog-NT-proBNP is a highly promising tool for course assessment of systemic ventricular load, independent of the age-related decline in physiological NT-proBNP concentration.
Competing Interests: Declaration of competing interest The authors report no relationships that could be construed as a conflict of interest
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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