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
2018
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.
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