| ObjectiveThis study was designed to detect the changes of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP)level in adult with left-to-right congenital heart defect at the stage Pre-and Post transcathetezer closure.Thus to investigate the relation between concentration of plasma NT-proBNP with degree of pulmonary artery hypertension artery hypertension(PAH) and cardiac loading condition and to evaluate operational effects of CHD.Methods8 3 cases with left-to-right shunt congenital heart disease(41 males, 42females) aged 18-49 years(mean:32±12.1 years) were enrolled in our study who received transcatheter interventional therapy successfully from June to Octerber 2010.Randomly recruited control group include 20 healthy people(10 males,10 females)aged18-49 years(mean:31±10.1 years).Before operation the subjects were divided into five groups according to their pulmonary artery mean pressure as follow:non-pulmonary hypertension group(mPAP<25 mmHg, n=36);mild pulmonary hypertension group(25 mmHg≤mPAP<35 mmHg, n=14);moderate pulmonary hypertension group(35 mmHg≤mPAP<50mmHg, n=12); severe pulmonary hypertension group (mPAP>50mmHg, n=21); control group (n=20).So as to follow-up the 83 cases were divided into four groups according to MPAP as follow:non-pulmonary hypertension group(n=36);mild pulmonary hypertension group(n=14);moderate pulmonary hypertension group(n=12); severe pulmonary hypertension group (n=21). The 83 cases were divided into three groups according to categories of CHD as follow:PDA(n=23),ASD(n=37),VSD(n=23).The right atrial pressure, right ventricular pressure,and pulmonary artery pressure were measured during right heart catheterisation before transcathetezer closure and after transcathetezer closure instantly.Cardiac size and hemodynamic index were measured by echocardiography before transcathetezer closure and 24h,96h,1 monthes and 3 monthes after transcatheter closure of CHD.The plasma NT-proBNPconcentrations in 83 patients with CHD were assayed by enzyme-linked immunoassay and radioimmunoassay respectively before transcathetezer closure, at 24h and 72h after transcatheter closure of CHD.Results1.The was significant difference about the Plasma NT-proBNP level before transcatheter closure in the five groups(P<0.01),Along with an increase in MPAP,the concentration of Plasma NT-proBNP elevated.The level of Plasma NT-proBNP in cases of serious PAH>moderate PAH>mild PAH>non-PAH group>control group(P<0.01).2.There was a positive correlation between NT-proBNP levels,MPAP,SPAP,and PVR before transcatheter closure.3.67.50pg/ml of Plasma NT-proBNP level dignose mild PAH with a sensitivity of 92.9%, and a specificity of 94.4%.147pg/ml of Plasma NT-proBNP level dignose moderate PAH with a sensitivity of 91.7%, and a specificity of 75.8%.236.5pg/mlof Plasma NT-proBNP level dignose serious PAH with a sensitivity of 95.2%, and a specificity of 73.0%.4.After transcatheter closure,the degree of SPAP gradually declined at once,24h and 96h in all PAH groups(P<0.05) and declined in 1mon,3mon in moderate PAH and serious PAH.But no difference was found about the change of SPAP in mild PAH and non-PAH in lmon, 3mon(P>0.05).5The Plasma NT-proBNP level of ASD,VSD and PDA is significantly higher after transcatheter closure immediately than those before transcatheter closure (P<0.05),but it gradually declined in the first day,the forth day,1 month and 3month(P<0.05).The Plasma NT-proBNP level of ASD and VSD was no difference between in the first day and before transcatheter closure(P>0.05).6.The diameter of RA and RV in ASD group was gradually decreased after transcatheter closure in three monthes, and the diameter of LA and LV in VSD or PDA group was gradually decreased after transcatheter closure in three monthes(P<0.05).7.In VSD and PDA patients, NT-proBNP levels positively correlated significantly with LA,LVEDD and SPAP,negatively correlated significantly with LVEF(P<0.01).In ASD patients,NT-proBNP levels positively correlated with RA and RVEDD(P<0.01).ConclusionBecause the Plasma NT-proBNP level of adult left-to-right CHD was gradually increased with the elevating of pulmonary artery pressure, it may be used as a marker to evaluate the degrees of PAH. NT-proBNP levels positively correlated significantly with LA,LVEDD and SPAP,negatively correlated significantly with LVEF in VSD and PDA patients,NT-proBNP levels positively correlated with RA and RVEDD in ASD patients,thus it may be reflect the changes of cardiac volume load and pressure load. The Plasma NT-proBNP level constantly declined after transcatheter closure with the decreasing of SPAP and enlarged chambers heart.It indicated that the Plasma NT-proBNP level could be used evaluated the effect of transcatheter closure in this kind of CHD. |
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