| Objective: To observe the changes of Tissue doppler Tei index(TDI-Tei index) and N-terminal pro-brain natriuretic peptide(NT-pro BNP) levels in children with left to right shunt congenital heart disease(CHD) before and after interventional therapy, explore the evaluation values of the two parameter on the changes of right cardiac function to provide the valuable references for clinical treatment.Methoods: We studied 90 children with left to right shunt CHD uncombined pulmonary hypertension with in the First Hospital of Hebei Medical University from November 2013 to November 2014,who received interventional therapy successfully. They have been confirmed by the echocardiography diagnosis.They include 48 male cases and 42 female cases. Their ages range from 3 to 13 years, the average age is 5.42±2.69 years.The subjects were divided into three groups according to the type of disease:30 cases in PDA group,30 cases in ASD group and 30 cases in VSD group.Clinical baseline information of all childen were recorded. Two milliliters venous blood were respectively extracted before the interventional therapy, 3 days and 3 months after the interventional therapy from all the subjects.The plasma NT-pro BNP were detected by bidirectional lateral flow immunoassay determination(fully automatic multi-function immunity analyzer,Re LIA SSJ-2).Echocardiography were performed in all the subjects before the procedure, 3days and 3months after the procedure. The parameters to evaluate the right cardiac function include the diameter of right ventricular(RVD), the diameter of right atrium(RAD), the right ventricular TDI-Tei index(RV-Tei index), Tricuspid annulus systolic peak velocity(TASa), tricuspid annulus systolic displacement(TAPSE), Tricuspid ring isochoric systolic myocardial acceleration(IVA), tricuspid annulus Ea/Aa. Ea/Aa to evaluate the right ventricular diastolic function, TASa, TAPSE and IVA to evaluate the right ventricular systolic function, the RV-Tei index to evaluate the right ventricular global function. The changes and the correlations of parameters before and after interventional therapy were analyzed.The children were observed about heart rate, blood pressure, heart murmur, the existence of arrhythmia, etc before interventional therapy, 3day and 3months after the interventional therapy. Statistical analysis: SPSS 19.0 software pack was used to make statistical analysis.Results:1 Clinical baseline characteristics of the subjectsThere were no obvious differences about sex,age,height,weight among three groups.(see Table 1).2 The change of plasma NT-pro BNP levelThere was significant difference about the plasma NT-pro BNP level before transcatheter closure in three groups, The level of NT-pro BNP in PDA group was highest(362.88±71.25pg/ml), while that in ASD group was lowest(259.49±43.99pg/ml). The concentration of plasma NT-pro BNP was compared with repeated measurements for statistical analysis of variance at each time point. The concentration of plasma NT-pro BNP was decreased gradually at 3d and 3 month after interventional therapy in three groups, until that at 3 month was lowest(P<0.01) and was respectively 108.46±36.88pg/ ml(PDA group),109.09±46.44pg/ml(VSD group), 102.11±34.53pg/ml(ASD group).(see Table 2)3 TDI-Tei index changesThere was significant difference about the TDI-Tei index before transcatheter closure in three groups, The TDI-Tie index in ASD group was highest(0.56±0.09), while that in PDA group was lowest(0.52±0.08). The TDI-Tei index was compared with repeated measurements for statistical analysis of variance after interventional therapy at each time point. The TDI-Tei index was decreased gradually at 3d and 3month after interventional therapy in three groups, until that at 3 month was lowest(P<0.01)and was respectively 0.21±0.04(ASD group), 0.26±0.08(VSD group), 0.24±0.09(PDA group).(see Table 3)4 The changes of Echocardiography atrioventricular structure and cardiac function parametersRAD were decreased significantly at 3 month after interventional therapy compared with those before operation in ASD group(22.76±2.32 mm vs 29.34±2.98 mm, P<0.01), while there were not obvious differencesin VSD and PDA group(P>0.05); RVD were decreased significantly at 3 month after interventional therapy compared with those before operation in ASD group(22.50±2.74 mm vs 28.84±4.02 mm, P<0.01),while there also were obvious differences in VSD and PDA group(24.33±2.00 mm vs 28.59±2.21 mm, 24.50±2.92 mm vs 28.31±3.20 mm, P<0.05); TAPSE, TASa were decreased at 3d after interventional therapy compared with those before operation in ASD group(16.56±2.87 mm vs 18.69±2.84 mm, 13.21±1.45cm/s vs 15.19±1.54cm/s, P<0.05), while there was no statistically significant at 3 month after interventional therapy(P>0.05). TAPSE, TASa were gradually increased after interventional therapy compared with those before operation in PDA group, until there were obvious differences at 3 month after interventional therapy(19.33±1.64 mm vs 16.63±1.65 mm, 16.01±1.77cm/s vs 12.61±1.51cm/s, P< 0.05), while there also were obvious differences in VSD group(20.17±2.04 mm vs 17.53±2.01 mm,17.79±2.31cm/s vs 14.09±2.23cm/s, P<0.05);Ea/Aa were gradually increased in three group after interventional therapy(P<0.05),while there were not obvious differences about IVA in the three group after interventional therapy(P>0.05).(see Table 4-6)5 The correlation among the parametersBefore and after interventional therapy, NT-pro BNP level and the TDI-Tei index was significantly positive correlated in ASD group(r=0.719,0.753,0.732, P<0.01), while the same as RAD and RVD(r=0.435,0.489;0.577,0.476; 0.513, 0.483;P<0.05).The TDI-Tei index and Ea/Aa was significantly negative correlated before and after interventional therapy in ASD group(r=-0.517,P<0.05). The NT-pro BNP level and TDI-Tei index were also significantly positive correlated before and after interventional therapy in PDA and VSD group(r=0.607,0.618,0.627; r=0.656,0.661,0.634; P<0.01),while the same as RVD(r=0.459,0.443,0.489; r=0.472,0.437,0.414; P<0.05). The NT-pro BNP level and IVA was not significantly correlated before and after interventional therapy in the there group(P>0.05), while the same as TAPSE and TASa(P>0.05).(see Table 7-9)6 There were no significant change of heart rate and blood pressure in all of the children before and after interventional therapy. The degree of heart murmur significantly reduced or disappeared. Five children had arrhythmia in a short time after the interventional therapy and all of them recovered. Only one child had intraventricular block.There was no death in the research.Conclusions:1 The interventional therapy stopped the abnormal shunting and eliminated the hypervolemia to the right heart. Because the ventricular tension was improved and the stimulation factors were relieved about myocardial cells, so the NT-pro BNP levels decreased before and after interventional therapy in children with left to right shunt CHD.2 The right ventricular TDI-Tei index has significantly decreased compared with no obvious changes of TAPSE and TASa, which might indicate that the change of TDI-Tei index had reflected the improvment of right cardiac function after interventional therapy in children with left to right shunt CHD in early stage. The correlations of TDI-Tei index and right cardiac function are better than TAPSE and TASa.3 The changes and the correlations of TDI-Tei index and plasma NT-pro BNP in the children with left to right shunt CHD after intervention operation indicated that TDI-Tei index and plasma NT-pro BNP could evaluate the improvement of right cardiac function. |
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