Comparison Of Pro-BNP Levels And Myocardial Performance Index Before And After Iron Treatment In Children With Congenital Cyanotic Heart Disease With Iron Deficiency Anemia

Yıl 2019, Cilt: 9 Sayı: 3, 197 - 202, 30.09.2019

Adnan Barutçu , Sevcan Erdem , Fadli Demir , Saliha Barutçu , Göksel Leblebisatan

https://doi.org/10.16899/jcm.598034

Öz

Introduction:
Our aim was to compare NT-proBNP levels and cardiac functions after iron
therapy in children with congenital cyanotic heart disease who had iron
deficiency anemia.

Materials
and Methods: We included 40 children with
pre-established cyanotic congenital heart disease and accompanying iron deficiency
anemia, between the age of 6 months and 17 years, who were admitted to the
outpatient clinic of Çukurova University Faculty of Medicine, Department of
Pediatric Cardiology between September 2015 and March 2016. We recorded
demographic data and performed following investigations: complete blood count,
peripheral blood smear, reticulocyte count, measurement of serum iron levels,
total iron-binding capacity, ferritin levels, transferrin saturation and
NT-proBNP levels, and echocardiographic examination.

Results:
There was a statistically significant increase in following laboratory
parameters after iron therapy: hemoglobin, hematocrit, MCV, MCHC, serum iron
and ferritin, transferrin saturation and oxygen saturation. During the
follow-up period, RDW and NT-proBNP levels were significantly decreased. In
left ventricular tissue doppler; there was a significant difference in MPI
measurements before and after treatment. There was no significant difference in
other echocardiography findings.

Conclusion:
Iron therapy has improved cardiac functions in children with cyanotic
congenital heart disease, and NT-proBNP levels can be used to evaluate the
efficacy of treatment in the follow-up period.

Anahtar Kelimeler

Cyanotic congenital heart disease, iron deficiency anemia, NT-proBNP, echocardiography

Demir Eksikliği Anemisi Olan Doğumsal Siyanotik Kalp Hastalıklı Çocuklarda Demir Tedavisi Öncesi ve Sonrası Pro-BNP Düzeyleri ve Miyokardiyal Performans İndekslerinin Karşılaştırılması

Öz

Amaç: Demir
eksikliği anemisi olan doğumsal siyanotik kalp hastalıklı çocuklarda demir
tedavisi sonrası NT-proBNP düzeyleri ve kardiyak fonksiyonların
karşılaştırılmasıdır.

Gereç
ve Yöntem:
Eylül 2015 - Mart 2016 tarihleri arasında
Çukurova Üniversitesi Tıp Fakültesi Çocuk Kardiyoloji Bilim Dalı polikliniğine
başvuran, siyanotik doğuştan kalp hastalığı tanılı, demir eksikliği anemisi
saptanan altı ay ile 17 yaşları arasındaki 40 çocuk hasta çalışmaya alınmıştır.
Çeşitli sebeplerden dolayı 26 hasta ile sonuçlar değerlendirilmiştir.
Hastaların ilk geliş ve üçüncü ay kontrollerinde; demografik verileri, tam kan
sayımı, periferik yayma, retikülosit, serum demir, total demir bağlama
kapasitesi, ferritin düzeyleri, transferrin satürasyonlarıu, NT-proBNP
düzeyleri ve Eko bulguları değerlendirilmiştir.

Bulgular: Hastaların
demir tedavisi öncesi ve sonrası laboratuvar değerlerinde; hemoglobin,
hematokrit, MCV, MCHC, demir, ferritin, transferin saturasyonu, oksijen saturasyonu
değerleri tedavi sonrası istatistiksel olarak anlamlı derece artmıştır. RDW ve
NT-proBNP düzeyleri yüksekliği kontrol sonuçlarında anlamlı olarak düşmüştür.
Sol ventrikül doku dopplerinde; MPİ ölçümlerinde tedavi öncesi ve sonrasında
anlamlı farklılık saptanmıştır. Diğer EKO bulgularında anlamlı farklılık
saptanmamıştır.

Sonuç: Demir
tedavisi sonrası siyanotik doğuştan kalp hastalıklı çocuklarda kardiyak
fonksiyonlarda iyileşme saptanmış olup NT-proBNP takipte, tedavinin
değerlendirilmesinde kullanılabilir.

Anahtar Kelimeler

Siyanotik doğuştan kalp hastalığı, demir eksikliği anemisi, NT-proBNP, ekokardiyografi

Kaynakça

• 1 Andrews N, Ullrich CK, Fleming MD. Disorders of iron metabolism and sideroblastic anemia. In: Nathan and Oski’s Hematology of Infancy and Childhood. 7th ed. Philadelphia: Saunders, 2008: 521–570.
• 2 Perloff JK, Roseve MH. Adults with cyanotic congenital heart disease: hematologic management. Ann Intern Med. 1988; 109:406-413.
• 3 Gershwin K. Davis, Fiona Bamforth, Amrita Sarpal, Frank Dicke, Yacov Rabi, Martha E. Lyon: B- type natriuretic peptide in pediatrics. Clinical Biochemistry 39. 2006; 600–605.
• 4 Amıram Nır, MD, and Nadera Nasser, MD. Clinical Value of NT-ProBNP and BNP in Pediatric Cardiology Journal of Cardiac Failure. 2005; 11:5
• 5 Hoffman JIE, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39:(12)1890–1900.
• 6 Candan I, Oral D. Cardiology. Ankara: Antıp Inc.- Baran Offset, 2002.
• 7 Capozzi G, Caputo S, Pizzuti R, Martina L, Santoro M, Santoro G. Congenital heart disease in live-born children: incidence, distribution, and yearly changes in the Campania Region. J Cardiovasc. Med. 2008;9(4):368-374.
• 8 Bernstein D. Epidemiology and genetic basis of congenital heart disease. Nelson Textbook of Pediatrics. 17th Ed, Philadelphia: Saunders, 2004.
• 9 Flanagan MF, Yeager SB, Weindling SN. Cardiac disease. Neonatology Pathophysiology & Management of the Newborn ,5th ed., Philadelphia: Lippincott, Williams&Wilkins, 1999.
• 10 Goel M, Shome DK, Singh ZN, Bhattachariee J, Khalil A. Hemostatic changes in children with cyanotic and acyanotic congenital heart disease. İndian Heart J, 2000; 52(5):559 – 63.
• 11 Prasad AN, Prasad C. Iron deficiency; non-hematological manifestations, Prog Food Nutr Sci 1991; 15: 225-283.
• 12 Gümrük F, Altay Ç. Iron metabolism and iron deficiency anemia. In: Özalp I (ed). KATKI Journal of Pediatrics 1995; 3 (16): 265-87.
• 13 Beard JL. Iron biology in immune function, muscle metabolism and neuronal functioning. J Nutr 2001; 131(2): 568-80.
• 14 Celkan T, Apak H, Özkan A, Bal Ş, Erener T, Çelik M, Yüksel L, Yıldız I. Prevention and treatment of iron deficiency anemia. Turkish Archive of Pediatrics 2000; 35(4): 226-231.
• 15 Gürkan B. Evaluation of congenital heart diseases. In: Yurdakök M, Erdem G (eds). Turkish Neonatology Society, The Book of Neonatology, 1st edition. Ankara: Alp Offset; 2004.
• 16 Morris CD. Lessons from epidemiology for the care of women with congenital heart disease. Prog Pediat. Cardiol 19 2004;1: p.5-13.
• 17 Rosenthal G. Prevalence of congenital heart disease. İn: Garson A, Bricker JT, Fisher DJ, Neish SR (eds). The Science and Practice of Pediatric Cardiology ,2nd ed. Vol II. Baltimore: Williams and Wilkins, 1998.
• 18 Samanek M. Boy/girl ratio in children born with different forms of cardiac malformation: a population-based study. Pediatr Cardiol 15. 1994; 53–57.
• 19 Onur CB, Sipahi T, Tavil B, Karademir S, Yoney A. Diagnosing iron deficiency in cyanotic heart disease. Indian J Pediat. 2003;70(1):29-31.
• 20 De Bold AT, Boronsteci HB, Veress AT, Sonnenberg H. A rapid and potent natriuretic response to intravenous injection of atrial myocardial extracts in rats. Life Sci 1981; 28: 89-94.
• 21 Willis MS, Lee ES, Grenache DG. Effect of anemia on plasma concentrations of NT-proBNP. Clin chim acta 2005; 358: 175-81.
• 22 Arati SD, Kirsten BD, Michael G. Association Between Anemia and N-Terminal Pro-B-Type Natriuretic peptide (NT-proBNP): Findings from the Heart and Soul Study. European Journal of Heart Failure 9 2007; 886–891.
• 23 Mika M, Takeshi T, Yoshiro N, Masaaki LK. Anemia as a factor that elevates plasma brain natriuretic peptide concentration in apparently healthy subjects. Int Heart J 2008; 49: 577-586.
• 24 Tekin Nas, S. Clinical significance of serum nt-probnp levels in the diagnosis of heart failure and follow-up of treatment in children with iron deficiency anemia. Inonu University, Faculty of Medicine 2010: 1-141.
• 25 Groenning BA, Nilson JC, Sondergaard L. Detection of left ventricular enlargement and impaired systolic function with plasma N-terminal pro brain natriuretic peptite concentrations. Am heart J 2002; 143: 923 9.