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

Jannet 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

doi:10.1016/j.ijcard.2014.04.137

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

Int J Cardiol. 2014 Jul 1;174(3):550-6. doi: 10.1016/j.ijcard.2014.04.137. Epub 2014 Apr 21.

Authors

Jannet A Eindhoven¹, Myrthe E Menting¹, Annemien E van den Bosch¹, Judith A A E Cuypers¹, Titia P E Ruys¹, Maarten Witsenburg¹, Jackie S McGhie¹, Eric Boersma¹, Jolien W Roos-Hesselink²

Affiliations

¹ Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
² Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: j.roos@erasmusmc.nl.

PMID: 24798786
DOI: 10.1016/j.ijcard.2014.04.137

Abstract

Background: 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.

Keywords: Corrected tetralogy of Fallot; Echocardiography; Exercise test; NT-proBNP; Speckle tracking echocardiography.

Publication types

Randomized Controlled Trial

MeSH terms

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*
Tetralogy of Fallot / diagnostic imaging
Tetralogy of Fallot / surgery*
Young Adult

Substances

Peptide Fragments
pro-brain natriuretic peptide (1-76)
Natriuretic Peptide, Brain