In children with left to right shunt congenital heart disease,the relationship of tissue doppler echocardiography findings with cardotrophin-1 and brain natriuretic peptit

Aim: Congenital heart disease is one of the major reasons of heart failure in children. In children with heart failure by means of advanced imaging methods like tissue Doppler echocardiography and new biochemical markers, cardiac dysfunction can be detected before clinical signs appear and degree of heart failure can be determined. In our study we aimed to examine the interaction of tissue Doppler echocardiography findings with serum cardiotrophin-1 (CT-1) and brain natriuretic peptide (BNP) levels in congenital heart diseases with left to right shunt and analyse the alterations of mentioned biochemical markers with intracardiac defect features. By this way we tried to obtain parameters that can be useful in early detection of left ventricule dysfunction in left to right shunt congenital heart diseases.Method: In our study, between the ages of 1 month and 13 years, 45 patients and 23 healthy children were investigated. In patient group, 19 patients had atrial septal defect (ASD), 17 patients had ventricular septal defect (VSD), 6 patients had ASD and VSD (ASD+VSD) and 3 patients had patent ductus arteriosus (PDA). To all children, additionally to classical echocardiographic assessments (two dimensional, M-Mode, two dimensional Doppler and colour Doppler echocardiography), tissue Doppler echocardiography (TDE) study was performed, from the basal regions of left ventricular (LV) lateral wall and interventricular septum (IVS). Myocardial performance indices (MPI) were calculated with time intervals obtained from both classical and tissue Doppler echocardiographies. In all cases, blood samples were obtained simultaneously with the echocardiography studies. Plasma BNP was determined by chemiluminescence immunoassay and CT-1 was determined by an enzyme-linked immunosorbent assay.Results: In the terms of classical echocardiography measurements, there was no statistical difference between the two groups. Only in patient group, mitral E/A ratio was lower than control (p<0,05). And similarly, TDE IVS E`/A` was also lower in patient group (p<0,05). TDE MPİ was positively correlated with intracardiac shunt in patient group (p<0,001, r=0,598). But, we saw that, amount of the shunt had not effect to the LV TDE MPI measurements. In the VSD and ASD+VSD groups, mitral E/IVS TDE E` ratio was higher than control group (p<0,05). And also in the general patient group, we showed a positive correlation between mitral E/IVS TDE E` ratio and intracardiac shunt (p=0,015, r=0,375). Although there was a positive correlation between BNP and intracardiac shunt (p<0,001, r=0,50), we didn`t find any correlations between BNP and other echocardiography parameters. In patient group, CT-1 was positively correlated with intracardiac shunt (p<0,02, r=0,35) and in ASD group CT-1 was correlated with diameter of the defect (p<0,05, r=0,49). And in patients with large VSD, CT-1 was higher from control group (p<0,05). We also found that in the higher intracardiac shunt group (pulmonary/systemic blood flow ratio is >2), CT-1 was negatively correlated with EF and FS (p<0,00001, r=0,71). But there weren`t any correlations between MPI, which was calculated by both two modalities, and CT-1 or BNP. In ASD group, CT-1 was negatively correlated with mitral E/IVS TDE E` (p<0,01, r=-0,68) and in VSD group, a positive correlation between IVS TDE E`/A` and CT-1 was determined (p<0,05, r=0,52).Conclusion: In our study it was determined that for the evaluation of left ventricule functions using classical Doppler and tissue Doppler echocardiography parameters together was better in reflecting the ventricule dysfunctions. Additionally, CT-1 which has been never studied in children before in spite of its use for assessment of heart failure in many cardiac diseases of adult, was higher in patient`s group. Furthermore, in patients with large intracardiac shunt and high risk of failure, pointing out the relation of echocardiographic parameters with CT-1 suggested the use of this biochemical marker as an indicator of cardiac dysfunction in left to right shunt heart diseases in an early period. In conclusion CT-1, is a marker that is candidate to be used in assessment of heart failure in children as in adults. However, prospective researches with greater number of patients are necessary to display the relationship between CT-1 and cardiac functions in childhood.Key words: Congenital heart defects, tissue Doppler echocardiography, cardiotrophin-1, brain natriuretic peptit.