Background:
Oxidative stress has recently been noted as a factor involved in myocardial remodeling and has been reported to be a predictor of heart failure severity and cardiac death in adults. However, its relevance in the pediatric field is unclear.
Objective:
This study aimed to investigate the reference range of oxidative stress dynamics and evaluate the role of oxidative stress in children with left to right shunt congenital heart disease (CHD).
Methods:
The subjects consisted of 40 patients (CHD group) with left to right shunt CHD who underwent cardiac catheterization at Hamamatsu University Hospital and 105 healthy children. The oxidative stress markers were measured in blood derivatives of reactive oxygen metabolites (ROM; adult reference value 250-300 U. CARR). We examined the dynamics of ROM in healthy children and then compared the various parameters, including ROM, in 40 age- and sex-matched healthy controls (control group).
Results:
The median age of the CHD group (21 boys and 19 girls) was 9.5 months (interquartile range: 2.8-32.0 months). CHD consisted of 27 cases of ventricular septal defect, 8 cases of atrial septal defect, 4 cases of patent ductus arteriosus, and 1 case of atrioventricular septal defect. In the healthy children, ROM showed a significant positive correlation with age (r = 0.482, p <0.001). The blood ROM of the CHD group (292 ± 84 U.CARR) was significantly higher (p <0.001) than that in the control group (199 ± 82 U.CARR), and the ROM showed a significant positive correlation with the pulmonary-to-systemic blood flow ratio (r = 0.333, p = 0.022), the percentage of left ventricular end diastolic volume (r = 0.503, p <0.001), and the percentage of right ventricular end diastolic volume (r = 0.771, p <0.001). The area under ROC curve of ROM for pulmonary-to-systemic-blood-flow ratio > 1.5 was 0.741 (95% CI: 0.576-0.906, p=0.026), with a cut-off value of 293 U.CARR.
Conclusions:
ROM, an indicator of oxidative stress, showed a gradual upward trend with age in childhood, and this transition was confirmed to differ from that of NT-proBNP, which decreases to a steady state after marked elevation in the early neonatal period. These findings suggest that ROM is a biological marker reflecting at least the volume load in left to right shunt CHD.
Clinical utility of two-dimensional Doppler echocardiographic techniques for estimating pulmonary to systemic blood flow ratios in children with left to right shunting atrial septal defect, ventricular septal defect or patent ductus arteriosus
