The predictive value of plasma B-type natriuretic peptide levels on outcome in children with pulmonary hypertension undergoing congenital heart surgery

Revista Brasileira de Anestesiologia

Ayse Baysal¹  Ahmet SŞaşmazel¹  Ayse Yildirim¹  Buket Ozyaprak¹  Narin Gundogus¹  Tuncer Kocak¹ 

关键词: Pediatrics;    Congenital heart defects;    Cardiopulmonary bypass;    B-type natriuretic peptide;    Outcome;    Postoperative;    Pediatria;    Cardiopatias congênitas;    Circulação extracorpórea;    Peptídeo natriurético tipo-B;    Desfecho;    Pós-operatório;    Pediatría;    Cardiopatías congénitas;    Circulación extracorporeal;    Péptido natriurético tipo B;    Resultado;    Postoperatorio;   

DOI  :  10.1016/j.bjane.2013.10.006

来源: SciELO

【 摘 要 】

Background and objectives:In children undergoing congenital heart surgery, plasma brain natriuretic peptide levels may have a role in development of low cardiac output syndrome that is defined as a combination of clinical findings and interventions to augment cardiac output in children with pulmonary hypertension.Methods:In a prospective observational study, fifty-one children undergoing congenital heart surgery with preoperative echocardiographic study showing pulmonary hypertension were enrolled. The plasma brain natriuretic peptide levels were collected before operation, 12, 24 and 48 h after operation. The patients enrolled into the study were divided into two groups depending on: (1) Development of LCOS which is defined as a combination of clinical findings or interventions to augment cardiac output postoperatively; (2) Determination of preoperative brain natriuretic peptide cut-off value by receiver operating curve analysis for low cardiac output syndrome. The secondary end points were: (1) duration of mechanical ventilation ≥72 h, (2) intensive care unit stay >7days, and (3) mortality.Results:The differences in preoperative and postoperative brain natriuretic peptide levels of patients with or without low cardiac output syndrome (n = 35, n = 16, respectively) showed significant differences in repeated measurement time points (p = 0.0001). The preoperative brain natriuretic peptide cut-off value of 125.5 pg mL−1 was found to have the highest sensitivity of 88.9% and specificity of 96.9% in predicting low cardiac output syndrome in patients with pulmonary hypertension. A good correlation was found between preoperative plasma brain natriuretic peptide level and duration of mechanical ventilation (r = 0.67, p = 0.0001).Conclusions:In patients with pulmonary hypertension undergoing congenital heart surgery, 91% of patients with preoperative plasma brain natriuretic peptide levels above 125.5 pg mL−1 are at risk of developing low cardiac output syndrome which is an important postoperative outcome.

【 授权许可】

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