学 位 論 文 の 要
k日 三
A
三 重 大 学 大 学 院 医 学 系 研 究 科 所 属 ｜ 甲 生 命 医 科 学 専 攻 臨 床 医 学 系 講 座
産 科 婦 人 科 学 分 野
主論文の題名
Plasma natriuretic peptide levels in fetuses with congenital heart defect and
arrhythmia: a single‑center prospective study
主論文の要旨
三 重 大 学
主 字 主 画 rず
Diagnose of fetal heart failure remains challenging because it is difficult to know how
well the fetal myocardium will perform as loading conditions. Natriuretic peptide (NP)
is established marker of heart failure. However, the number of studies investigating NP
levels in fetuses is quite limited. Thus, we evaluate the significance of NP levels in the
assessment of heart failure in fetuses with congenital heart defect (CHD) and
arrhythmia. This was a prospective observational study at a tertiary pediatric cardiac
center. A total of 129 singletons with CHD or arrhythmia, and 127 controls from 2012
to 2015 were analyzed. Umbilical cord plasma NP levels at birth were compared with
ultrasonography findings indicating heart failure such as cardiovascular profile (CVP)
score and morphological characteristics. Fetus with CHD or arrhythmia had higher NP
levels than controls
(P
く0.01). NP levels of fetuses with CHD or arrhythmia were
inversely correlated with CVP score
(P
for trend く0.01).No differences were found in
NP levels between fetuses with CHD or arrhythmia and CVP score
三
8versus controls.
Multivariate analysis showed that CVP score
三
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 CVP score S.7, abnormal venous Doppler
sonography findings were more common and more severe in fetuses with tachy‑ or
bradyarrhythmia than those with CHD, and fetuses with tachy‑or bradyarrhythmia had
higher NP levels than those with CHD (P=0.01). Fetuses with right heart defect and
moderate or severe tricuspid valve regurgitation had significantly higher NP levels than
those with other types of CHD
(P
く0.01).In conclusion, plasma NP levels in fetus with
CHD or arrhythmia 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 CHD, rather than the
morphological abnormality itself.
