Free Paper Oral 21 (I-OR21)

[I-OR21-02] 成人先天性心疾患におけるグレリンと心不全

^○椎名 由美¹, 村上 智明³, 松元 紀子², 西畑 庸介¹, 福田 旭伸¹, 川松 直人¹, 木島 康文¹, 小宮山 伸之¹, 丹羽 公一郎¹ (1.聖路加国際病院 循環器内科, 2.聖路加国際病院 栄養科, 3.千葉こども病院 循環器科)

Keywords:ghrelin, heart failure, ACHD

Background:In children with CHD, plasma ghrelin level is raised.Raised ghrelin induces growth hormone release and may prevent heart failure, whereas there has been no data after reaching adulthood. Aim: To assess the plasma ghrelin level in adults with CHD and to evaluate the association of some hormones and cytokines including ghrelin, leptin, IL-6 and TNF-α and heart failure.Methods: Prospectively, we enrolled 46 consecutive adults with CHD and 12 age matched healthy controls: 13 patients with Fontan circulation (Group A), 16 cyanotic patients with no repair or only palliative repair (Group B), and 17 patients with repaired tetralogy of Fallot (TOF) (Group C). Results: The mean age of all patients was 32.1+/-7.4 years. In Group A and B, ghrelin level, skeletal muscle mass index, and basal metabolism were significantly lower than those in controls, whereas there was no statistical difference between C and D. IL-6 and edema index in Group A and B were higher than those in controls. Percent body fat was the highest in Group B. On a logistic analysis, ghrelin level, edema index, percent body fat, NT-pro BNP, and SPO2 were important factors associated with NYHA FC ≧3 and/or histories of hospitalization due to heart failure. Conclusions: Ghrelin level in Fontan circulation and cyanotic CHD are significantly decreased, and ghrelin and body fat are the important factors associated with heart failure. Decreased ghrelin is a good influence on obesity, whereas this fact suggests an adverse effect on heart failure.