engleski

Low birth weight and etiology of heart failure at adult age – can NTproBNP provide additional data?

Purpose: It is well known that antenatal conditions and genetic structure determine postnatal growth, with proven influence on susceptibility to adult cardiovascular diseases, especially ischemic heart disease. Conversely, the influence of fetal growth restriction (evident by low birth weight-LBW) on non-ischemic cardiomyopathies (CMP) in adults has not been studied. We studied our center’s heart failure population, and compared birth weights (BW) and NT-proBNP (brain natriuretic peptide) levels among different patient groups. Methods: During 2012 and 2013 628 adult patients with different types of CMP were hospitalized in our center. Birth weight data were available for 130 patients ; these patients were included in our observational study. The patients were categorized in groups according to the respective etiology of CMP: 49 patients had idiopathic CMP, 37 had ischemic CMP, 20 patients had secondary CMP (valvular, toxic or hypertensive), 14 patients had postmyocarditic CMP, 5 patients had hypertrophic CMP (HCM), and 5 patients had ARVD. The cut-off value for LBW was set at 2500g. We also recorded maximum NT-proBNP values. Results: Average BWs among subgroups were as follows: postmyocarditic CMP 3135°æ743 g, ARVD 3414°æ250 g, ischaemic 3543°æ852 g, idiopathic CMP 3547°æ845 g, secondary CMP 3763°æ568 g, and HCM 3930°æ980 g. The lowest BW was found in postmyocarditic CMP and was shown to be significantly lower compared to the ischemic CMP group (p=0.05). Average NT-proBNP values (pg/ml) among subgroups were as follows: idiopathic CMP 5780°æ5734, postmyocarditic CMP 6216°æ3879, ischaemic CMP 3473°æ3708, secondary CMP 2695°æ2089, HCM 1719°æ1027, and ARVD 1487°æ2033. NT-proBNP was significantly higher in patients with idiopathic and postmyocarditic CMP, compared to ischaemic CMP (p=0.03 and p=0.02 respectively). Furthermore, in the group of patients with idiopathic CMP, the patients with LBW had significantly higher NT-proBNP values (102763°æ9227 pg/ml) than patients with normal birth weight (5245°æ5137 pg/ml ; p=0.03). Considering all data, BW showed a weak but significant negative correlation to NT-proBNP values (Pearson correlation coefficient -0.17 (p=0.02)). Conclusion: This observational study supports our previous findings of lower average BW among postmyocarditic CMP patients. An association was also established between LBW and NT-proBNP values in patients with idiopathic CMP. Additionally, birth weights were negatively correlated to NT-proBNP values. These data could potentially contribute to the fetal programming thesis, indicating that “in-utero” stress makes a lifelong influence on the CV system.

Low birth weight; heart failure; NTproBNP

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