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Associations between N-terminal pro-B-type natriuretic peptide and cardiac function in adults with corrected tetralogy of Fallot.

AbstractBACKGROUND:
Amino-terminal B-type natriuretic peptide (NT-proBNP) may detect early cardiac dysfunction in adults with tetralogy of Fallot (ToF) late after corrective surgery. We aimed to determine the value of NT-proBNP in adults with ToF and establish its relationship with echocardiography and exercise capacity.
METHODS AND RESULTS:
NT-proBNP measurement, electrocardiography and detailed 2D-echocardiography were performed on the same day in 177 consecutive adults with ToF (mean age 34.6 ± 11.8 years, 58% male, 89% NYHA I, 29.3 ± 8.5 years after surgical correction). Thirty-eight percent of the patients also underwent a cardiopulmonary-exercise test. Median NT-proBNP was 16 [IQR 6.7-33.6] pmol/L, and was elevated in 55%. NT-proBNP correlated with right ventricular (RV) dilatation (r = 0.271, p < 0.001) and RV systolic dysfunction (r = -0.195, p = 0.022), but more strongly with LV systolic dysfunction (r=-0.367, p<0.001), which was present in 69 patients (39%). Moderate or severe pulmonary regurgitation was not associated with higher NT-proBNP. Tricuspid and pulmonary regurgitation peak velocities correlated with NT-proBNP (r = 0.305, p < 0.001 and r = 0.186, p = 0.045, respectively). LV twist was measured with speckle-tracking echocardiography in 71 patients. An abnormal LV twist (20 patients, 28%) was associated with elevated NT-proBNP (p = 0.030). No relationship between NT-proBNP and exercise capacity was found.
CONCLUSIONS:
NT-proBNP levels are elevated in more than 50% of adults with corrected ToF, while they are in stable clinical condition. Higher NT-proBNP is most strongly associated with elevated pulmonary pressures, and with LV dysfunction rather than RV dysfunction. NT-proBNP has the potential to become routine examination in patients with ToF to monitor ventricular function and may be used for timely detection of clinical deterioration.
AuthorsJannet A Eindhoven, Myrthe E Menting, Annemien E van den Bosch, Judith A A E Cuypers, Titia P E Ruys, Maarten Witsenburg, Jackie S McGhie, Eric Boersma, Jolien W Roos-Hesselink
JournalInternational journal of cardiology (Int J Cardiol) Vol. 174 Issue 3 Pg. 550-6 (Jul 01 2014) ISSN: 1874-1754 [Electronic] Netherlands
PMID24798786 (Publication Type: Journal Article, Randomized Controlled Trial)
CopyrightCopyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Chemical References
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
Topics
  • Adult
  • Cross-Sectional Studies
  • Echocardiography (methods)
  • Electrocardiography (methods)
  • Exercise Test (methods)
  • Female
  • Heart Function Tests (methods)
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain (blood)
  • Peptide Fragments (blood)
  • Tetralogy of Fallot (blood, diagnostic imaging, surgery)
  • Young Adult

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