Clinical Research Of Plasma BNP And Echocardiographic Right Ventricular Function In Children With Left-to-right Shunting CHD Associated Pulmonary Artery Hypertension

Objective:To evaluate the changes of plasma brain natriuretic peptide and echocardiographic parameters of right ventricular function in children with pulmonary artery hypertension(PAH) secondary to left-to-right shunting CHD.The parameters including right ventricular FAC,Tei index and two-dimensional longitudinal strain(GLS,Sb,Sin) and strain rate(GLSR).Then analyze the correlation of plasma BNP with PASP, Qp/Qs and the echocardiographic parameters.It is further to evaluate the diagnostic value of plasma BNP in PAH secondary to CHD.Methods:65 patients with left-to-right shunting CHD were involved in our research. The controls were 30 age-matched children who were in hospital waiting for selective operation.The patients were divided into CHD without PAH group(non PAH group) 17 cases and CHD with PAH group(PAH group) 48 cases.The PAH group were divided into mild(15 cases),moderate(18 cases) and severe(15 cases) subgroups according to their pulmonary pressure.Echocardiography was carried out within 48 hours after blood examination.The diameters of aorta and pulmonary artery and the pulse Doppler flow of the four valvular orifice imagings were obtained with GE VIVID 7.Two-dimensional standard apical four-chamber image of consecutive three cardiac cycles were preserved to Echopac workstation.Plasma BNP were detected with Enzyme-linked Immunoadsordent assay.The measurement data was represented by(?)±s.Plasma BNP and echocardiographic parameters in each group and subgroups were compared by one-way ANOVA.We analyzed the relationship between plasma BNP and PASR Qp/Qs, echocardiographic parameters by linear correlation analysis test and stepwise regression.Results:1.Plasma BNP was higher in PAH group than in non-PAH group and controls(P＜0.01),and Plasma BNP increased in accordance with PAH(P＜0.05).2.Tei index was higher in PAH group than in non-PAH group and controls(P＜0.01),and in subgroups,severe group was significantly higher than the other groups(P＜0.05).3.FAC, GLS,GLSR,Sb,Sm were significantly lower in PAH group than in non-PAH group and controls(P＜0.01).In subgroups,FAC,GLS and Sb yielded a gradual decrease with worsening PAH,there were significant difference inter subgroups(P＜0.05).4.Plasma BNP had significantly positive correlation with PASP(r=0.659,P＜0.001) and with Qp/Qs (r=0.323,P=0.025).5.Plasma BNP had a strongly positive correlation with Tel index(r =0.505,P＜0.001) and negative correlation with GLS,GLSR(r=-0.625,P＜0.001;r =-0.318,P=0.028).There had no statistics significant correlation between plasma BNP and FAC(r=-0.166,P=0.261).6.Stepwise regression analysis demonstrated that GLS and Tei index were independent determinants of plasma BNP(r=-0.403 and 0.178,P＜0.01 and P＜0.05 respectively).Plasma BNP may be helpful in diagnosis of PAH secondary to left-to-right CHD,area under the curve of ROC was 0.968,95%CI:0.93～1.01,P＜0.001.Conclusion:1.Plasma BNP were increased in children with PAH secondary to left-to-right CHD,and it increased as the degree of PAH increased.Plasma BNP had good correlation with PASP and Qp/Qs.It demonstrated that Plasma BNP reflected pressure and volume overload of CHD-PAH.Plasma BNP might be done as an objective index in auxiliary diagnosis and the severity appraisal of the left-to-right shunting CHD.2.Tei index increased obviously in severe PAH.FAC,GLS,Sb,Sm,GLSR deceased in PAH group,validating right ventricular disfimction in PAH secondary to CHD.FAC,GLS,Sb decreased as worsening PAH,indicated fight ventricular function impaired with the increasing degree of PAH.FAC,GLS and Sb could differentiate the degree of PAH.3. There were good correlation between Plasma BNP and Tei index,GLS GLSR,so we considered combining these variables to correctly evaluate right ventricular function.