Predictive Value Of Myocardial Damage Biomarkers In Cardiac Function Of Infants With Isolated Ventricular Septal Defect

Objective To study the level changes of myocardial damage biomarkers and echocardiographic parameters in infants with isolated ventricular septal defect(i-VSD),analyze the relationship between myocardial damage biomarkers and echocardiographic parameters,and explore the application value of both markers in cardiac repair surgery of infants with i-VSD.Methods A total of 184 i-VSD infants treated in the outpatient department and inpatient Department of the People’s Hospital of Inner Mongolia Autonomous Region from January2015 to December 2021 were selected to collect myocardial damage biomarkers [e.g.serum N-terminal pro-brain natriuretic peptide(NT-pro BNP),heart-type fatty acid-binding protein(H-FABP),cardiac troponin I(c Tn I),creatine kinase MB(CK-MB),creatine kinase(CK)]and echocardiographic parameters [e.g.aortic diameter(AOD),right ventricular outflow tract(RVOT),main pulmonary artery diameter(PAD),left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular cardiac output(LVCO),left atrial diameter(LAD),right ventricular end diastolic diameter(RVEDD),left ventricular ejection fraction(LVEF),left ventricular fraction shortening(LVFS)and defect diameter(DD)],etc.The infants with I-VSD were divided into three groups according to DD:small group(≤3mm)77 cases,medium group(>3mm,<5mm)76 cases,large group(≥5mm,≤10mm)31 cases.The differences of myocardial damage biomarkers and parameters of echocardiography among the three groups were compared,and the correlation between myocardial damage biomarkers and parameters of echocardiography were analyzed.Infants with i-VSD were divided into surgical group(62 cases)and non-surgical group(122cases)according to whether cardiac repair surgery was performed,to explore the predictive value of myocardial damage biomarkers and echocardiographic parameters in cardiac repair surgery for infants with i-VSD.Results 1.The serum levels of NT-pro BNP,H-FABP,c Tn I,CK-MB,CK and CK-MB/CK increased with the increase of the defect diameter,and there were statistically significant differences among the small group,medium group and large group(P<0.05;Table 2).2.The echocardiographic parameters of LVCO,LVEDD,LVESD,LAD,PAD,RVEDD and RVOT in large group were significantly higher than those in small and medium groups(P< 0.05).The LAD level in medium group was higher than that in small group(P< 0.05).There was no significant difference in HR,AOD,LVEF and LVFS among the three groups(P>0.05).3.Serum NT-pro BNP,H-FABP,c Tn I,CK-MB,CK and CK-MB/CK were significantly positively correlated with each other(P<0.05).For example,serum NT-pro BNP was significantly positively correlated with c Tn I(r=0.819,P<0.05).4.The serum levels of NT-pro BNP,H-FABP,c Tn I,CK-MB,CK and CK-MB/CK were significantly positively correlated with DD,DD/AOD,DD/LVEDD,DD/LAD,LVESD,LVEDD,LAD/AOD,PAD,LVCO and LAD levels(P<0.05).5.Series combined detection of serum NT-pro BNP,H-FABP,c Tn I,CK-MB and CK predicted that the area under receiver operator characteristic curve of infants with i-VSD requiring cardiac repair surgery was the largest,and AUC was 0.895,sensitivity was 87.10%,specificity was 80.33%.The cut off value of serum NT-pro BNP for predicting cardiac repair surgery in infants with i-VSD was 266.9ng/L,and AUC was 0.877,sensitivity was 69.35%,specificity was 87.70%.The cut off value of LAD/AOD for predicting cardiac repair surgery in infants with i-VSD was 1.3,and the AUC was 0.800,the sensitivity was 74.19%,the specificity was 74.59%.Conclusion Clinical monitoring of myocardial damage biomarkers(such as serum NT-pro BNP,H-FABP,c Tn I,CK-MB and CK)and echocardiography(such as LVCO,LVEDD,LVESD,LAD,PAD,RVEDD and RVOT)in infants with i-VSD are important to evaluate the cardiac function of infants with i-VSD.Myocardial damage biomarkers are sensitive markers for the early detection of myocardial injury in infants with i-VSD,and their levels can increase before ventricular dilation or cardiac insufficiency occurs.The combined application of myocardial damage biomarkers and echocardiography is beneficial to provide early,timely and effective reference parameters for clinical management of infants with i-VSD,and may improve the accuracy of clinicians to predict that i-VSD infants should undergo cardiac repair surgery,so as to develop reasonable management plans for the treatment of infants with i-VSD.