Az N-terminális pro-B natriureticus peptid jelentősége a felnőtt korú congenitalis szívbetegek gondozásában – Eredmények a CSONGRAD Regiszterből = The significance of N-terminal pro-B natriuretic peptide in the management of adult patients with congenital heart disease – Results from the CSONGRAD Registry

Absztrakt: Bevezetes: Kronikus szivelegtelensegben es congenitalis szivbetegsegekben etiologiatol fuggetlenul igazoltak a B-tipusu natriureticus peptid (BNP)-szint prognosztikai szerepet is. Celkitűzes: A jelen vizsgalat celja a klinikai rutinban merhető N-terminalis pro-B natriureticus peptid (NT-proBNP) es a fontosabb klinikai es echokardiografias parameterek osszehasonlitasa volt az altalunk gondozott felnőtt koru congenitalis szivbetegekben. Modszer: Osszesen 70 beteg adatait dolgoztuk fel. A diagnozis 34 betegnel korrigalt Fallot‑tetralogia es 19 esetben korrigalt teljes nagyer-transzpozicio volt. Tizenhet esetben egyeb congenitalis vitiumos beteg tartozott a vizsgalati csoportba. Valamennyi esetben ambulans vizsgalat tortent elektrokardiografiaval, echokardiografiaval es NT‑proBNP-meressel kiegeszitve. Meghataroztuk a szivelegtelenseg New York Heart Association (NYHA) szerinti stadiumat, es a betegek az eletminősegukkel kapcsolatos kerdőivet is kitoltottek. Eredmenyek: A magasabb NT‑proBNP-szint rosszabb eletminőseggel (visual analogue scale, VAS) es nagyobb jobb kamrai vegdiasztoles atmerővel jart egyutt, es az arrhythmiak előfordulasa is magasabb volt. Negativ korrelacio volt igazolhato az NT‑proBNP-szint es a betegek VAS-pontszama (r = –0,45, p = 0,0001), valamint a bal kamrai ejekcios frakcio (BK-EF) kozott (r = –0,67, p<0,0001). A ROC-analizis soran az NT‑proBNP≥668 pg/ml-t talaltuk a legnagyobb pontossagu hatarerteknek a NYHA III–IV. stadium előrejelzeseben (szenzitivitas 93%, specificitas 63%, gorbe alatti terulet 80%, p = 0,001). Hasonloan, az NT‑proBNP≥184,7 pg/ml-t talaltuk a legnagyobb pontossagunak az 55%-nal kisebb BK-EF előrejelzeseben (szenzitivitas 66%, specificitas 67%, gorbe alatti terulet 77%, p = 0,02). Kovetkeztetesek: Az NT-proBNP-nek jelentősege van a felnőtt koru komplex congenitalis szivbetegseggel biro betegek megiteleseben, prognozisuk meghatarozasaban, es a betegek utankovetesere alkalmazott egyeb vizsgalomodszerek mellett segithet a reoperacio vagy az esetleges szivtranszplantacio idejenek kivalasztasaban. Orv Hetil. 2018; 159(4): 141–148. | Abstract: Introduction: The prognostic role of B-type natriuretic peptide (BNP) level was confirmed in chronic heart failure and congenital heart diseases irrespective of the aetiology. Aim: The aim of this study was to compare NT‑proBNP measured in the clinical practice and important clinical and echocardiographic parameters in patients with adult congenital heart diseases under our care. Method: Data of a total of 70 patients were analysed; 34 patients had corrected tetralogy of Fallot and 19 patients had corrected transposition of the great arteries. In 17 further cases, patients with other congenital vitiums have been involved in the study. In all cases, out-patient examination was performed with electrocardiography, echocardiography and NT-proBNP measurement. The New York Heart Association (NYHA) stages of the patients were determined and the patients filled in a questionnaire regarding their quality of life. Results: Elevated NT-proBNP level resulted in a worse quality of life (visual analogue scale, VAS) and an increased right ventricular end diastolic diameter; the incidence of arrhythmia increased as well. Negative correlation was found between the NT-proBNP level and the VAS value (r = –0.45, p = 0.0001) and the left ventricular ejection fraction (LV-EF) (r = –0.67, p = <0.0001). ROC analysis showed that NT‑proBNP≥668.1 pg/ml was the cut-off value that most accurately predicted NYHA class III–IV (sensitivity 93%, specificity 63%, area under the curve 80%, p = 0.001). Similarly, NT-proBNP≥184.7 pg/ml was found to be the cut-off value most accurately predicting LV-EF below 55% (sensitivity 66%, specificity 67%, area under the curve 77%, p = 0.02). Conclusions: NT-proBNP has a role in the evaluation of adult patients with congenital heart diseases and in determining the prognosis of these patients, and in addition to other examinations used in the follow-up of these patients, NT-proBNP may help in determining the time of reoperation or potential heart transplantation. Orv Hetil. 2018; 159(4): 141–148.