Predictive value of cardiac biomarkers of low cardiac output in children undergoing congenital heart surgery / 中华胸心血管外科杂志

ABSTRACT

Objective:To assess the predictive value of atrial natriuretic peptide, b-type natriuretic peptide(BNP), cardiac troponin I(cTn-I) and central venose oxygen saturation(ScvO 2)as indicators of low cardiac output syndrome(LCOS) in children with congenital heart disease undergoing cardiopulmonary bypass(CPB). Methods:After corrective surgery for congenital heart disease under CPB, 70 children(aged 5 days to 160 months) were enrolled in a prospective observational pilot study during 1-year period from April 2017 to March 2018. The patients were classified according to whether they developed low cardiac output syndrome. Biomarker levels were measured at 2, 12, 24, and 48 h post-CPB. The clinical data and outcome variables were analyzed by a multiple logistic regression model. Results:Twenty-two(31.4%) patients developed low cardiac output syndrome(group 1) and the remaining 48(68.6%) patients were included in group 2. cTn-I levels >13 ng/ml at 2 hours after CPB( OR=40.2, 95% CI 9.4-171.4, P<0.001) and ScvO 2 levels<0.37 at 12 hours following CPB( OR=124.7, 95% CI 28.7-538.2, P<0.001) were independent predictors of low cardiac output syndrome. Conclusion:Our results suggest that cTn-I at 2 h and ScvO 2 levels at 12 h post-CPB are evident early predictors of low cardiac output syndrome. This predictive capacity is, moreover, reinforced when cTn-I combined with ScvO 2 following CPB. These 2 cardiac biomarkers would aid in therapeutic decision-making in clinical practice and would also enable clinicians to modify the type of support to be used in the pediatric intensive care unit.