【博士論文】学術データベース

博士論文 / Plasma natriuretic peptide levels in fetuses with congenital heart defect and arrhythmia: a single-center prospective study

著者

書誌事項

タイトル

Plasma natriuretic peptide levels in fetuses with congenital heart defect and arrhythmia: a single-center prospective study

著者名

三好剛一

著者名

MIYOSHI Takekazu

学位授与大学

三重大学 (大学ID:0046) (CAT機関ID:KI000538)

取得学位

博士(医学)

学位授与番号

甲医学第1873号

学位授与年月日

2017-12-20

注記・抄録

Objectives:Diagnosing fetal heart failure remains challenging because it is difficult to know how well the fetal myocardium will perform as loading conditions change. In adult cardiology, natriuretic peptides (NPs) are established marker of heart failure. However, the number of studies investigating NP levels in fetuses is quite limited. The aim of this study was to evaluate the significance of plasma NP levels in the assessment of heart failure in fetuses with congenital heart defect (CHD) and arrhythmia. Methods:This was a prospective observational study at a tertiary pediatric cardiac center. A total of 129 singletons with CHD, arrhythmia, or both and 127 controls from 2012 to 2015 were analyzed. Umbilical cord plasma atrial NP, brain NP and N-terminal pro-brain NP levels at birth were compared with ultrasonography findings indicating fetal heart failure such as a cardiovascular profile (CVP) score and morphological characteristics. Results:Fetuses with CHD, arrhythmia, or both had higher NP levels than controls (P<0.01). NP levels of fetuses with CHD, arrhythmia, or both were inversely correlated with CVP score (P for trend <0.01). No differences were found in NP levels between fetuses with CHD or arrhythmia and a CVP score of ≥8 versus controls. Multivariate analysis showed that a CVP score of ≤5, tachy- or bradyarrhythmia at birth, preterm birth, and umbilical artery pH <7.15 are independently associated with high NP levels (P<0.01). Among fetuses with a CVP score of ≤7, abnormal venous Doppler sonography findings were significantly more common and more severe in fetuses with tachy- or bradyarrhythmia than those with CHDs, and fetuses with tachy- or bradyarrhythmia had higher NP levels than those with CHDs (P=0.01). Fetuses with right heart defect and moderate or severe tricuspid valve regurgitation had significantly higher NP levels than fetuses with other types of CHD (P<0.01). Conclusions:Plasma NP levels in fetuses with CHD, arrhythmia, or both are correlated with the severity of fetal heart failure. Elevated NP levels are mainly attributed to increases in central venous pressure secondary to arrhythmia or atrioventricular valve regurgitation due to a CHD, rather than the morphological abnormality itself.

本文 / Department of Perinatology and Gynecology

35p

内容の要旨・審査結果の要旨 / 三重大学大学院医学系研究科 生命医科学専攻 臨床医学系講座 産科婦人科学分野

キーワード

Heart Failure, natriuretic peptide, arrhythmia, cardiovascular profile score, congenital heart defect, prenatal diagnosis

各種コード

NII論文ID(NAID)

500001054954

NII著者ID(NRID)
  • 8000001172701
  • 8000001172702
DOI (出版社)

10.1002/uog.18925

本文言語コード

eng

データ提供元

機関リポジトリ / NDLデジタルコレクション

外部リンク

博士論文 / 三重大学 / 医学

博士論文 / 三重大学

博士論文 / 医学

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