Research Of N-terminal Pro-Brain Nitric Peptide For Congenital Heart Disease With Pulmonary Hypertension

Objective: Pulmonary arterial hypertension (PAH) leads to substantial morbidity and mortality for congenital heart disease. Noninvasive parameters in the follow-up assessment of PAH could be helpful in clinical decision making. The N-terminal pro-brain nitric peptide (Nt-proBNP) has been shown to correlate with the functional status and prognosis of these patients and could be a valuable parameter in this respect. The aim of our study was to investigate whether Nt-proBNP levels could reflect clinical and hemodynamic changes, including the response to surgery in patients with PAH.Methods: Thirty patients with PAH (15 male and 15 female;from 0.5 to 51 years,mean 13.2 years), were included in the study. Patients were divided for 2 groups according to PAP measured with echocardiogram (patients with PAP >30mmHg were submit to study-group, others to contra-group). Exclusion criteria were impaired renal function (serum creatinine level> 110umol/L), decreased left heart function (EF<50%), and stenosis of outlet of right ventricle. The Nt-proBNP concentrations, the pulmonary artery pressure (PAP) and the left ventricular ejection fraction (LVEF) were measured before cardiac surgery, 24 hours, 7 days and 14 days after operation. Analyze the trend of Nt-proBNP concentration and study relationship of Nt-proBNP and PAP, LVEF.Results: The preoperative Nt-proBNP level in study-group was the base line (624. 9 ± 54. 76pg/ml), it elevated markedly and acutely to a peak value 24 hours after operation (1946.0 ± 229.23pg/ml) (P<0.01), then the BNP decreased (975. 6±153. 77pg/ml) 7 days later, but was still higher than the concentration before operation (P<0.01), 14 days later it reached to the concentration (657. 3 ± 66. 98pg/ml) before operation, but there was no significant difference (P=0.73). There was positivedifferences between study-group and contra-group (p<0.01) in all 4 time points.Therewas a positive and negative correlation between PAP> LVEF and Nt-proBNP(multiple correlation coefficient R2=0. 69, P<0. 0001).Conclusion: We concluded that Nt-proBNP levels parallel changes with PAP .TheNt-proBNP concentration can reflect PAP(R>0.7). Consequently, we suggestNt-proBNP as a parameter for the follow-up assessment of PAH patients.