RESUMO
AIMS: To assess plasma B-type natriuretic peptide (BNP) levels in patients with univentricular hearts late after volume unloading by total cavopulmonary connection (TCPC). METHODS: Plasma BNP was measured by sandwich immunoassay in 67 patients after a modified Fontan procedure. BNP levels were compared with age and sex-specific normal values, clinical and echocardiographic data, and results of exercise testing. RESULTS: BNP had a wide range of 5-290 pg/ml, but was normal in 81% of patients, and median BNP was only 13 pg/ml. There was no difference between males and females, between patients with left or right ventricular morphology, and no correlation was found between BNP and age, post-operative follow-up period, maximum exercise capability, peak oxygen uptake, or blood oxygen saturation. New York Heart Association class I patients had lower BNP than class II patients (p=0.04). Plasma BNP concentration was positively correlated to the number of specific sequelae (r=0.59, p<0.001), and to severity of atrioventricular regurgitation (r=0.38, p=0.002). 5/13 patients with elevated BNP died during follow-up. CONCLUSION: BNP plasma concentration was normal in the majority of patients up to 15 years after TCPC. Elevated and increasing BNP levels were associated with increased morbidity and late mortality.
Assuntos
Técnica de Fontan/métodos , Cardiopatias Congênitas/sangue , Peptídeo Natriurético Encefálico/sangue , Adolescente , Adulto , Insuficiência da Valva Aórtica/complicações , Criança , Pré-Escolar , Feminino , Técnica de Fontan/mortalidade , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/cirurgia , Humanos , Estudos Longitudinais , Masculino , Artéria Pulmonar/cirurgia , Fatores de Risco , Resultado do Tratamento , Veia Cava Inferior/cirurgiaRESUMO
OBJECTIVE: To examine the diagnostic value of B-type natriuretic peptide (BNP) in patients with systemic right ventricle. METHODS: Plasma BNP levels were measured in 48 outpatients with D-transposition of the great arteries after atrial switch procedure or congenitally corrected transposition of the great arteries. RESULTS: Plasma BNP was < or =20 pg/ml in 52% and <200 pg/ml in all patients, significantly higher in females compared to males (p = 0.004), and positively correlated with age (r = 0.3, p = 0.04). New York Heart Association class I patients had significantly lower BNP than class II patients (p = 0.03). A positive correlation was found between BNP and severity of tricuspid regurgitation (r = 0.5, p < 0.001). Plasma BNP was weakly, negatively correlated to maximum exercise capability, peak oxygen uptake, maximum heart rate during exercise testing and minimal heart rate in the 24-hour Holter monitoring. Additionally, BNP was negatively correlated with flow velocity across the pulmonary valve in patients with congenitally corrected transposition of the great arteries (r = -0.81, p = 0.03). CONCLUSION: Plasma BNP is normal in patients with systemic right ventricle, but increases with deterioration of clinical status and decreasing exercise capability. BNP is positively correlated with severity of tricuspid regurgitation, a prognostic factor for survival.
Assuntos
Cardiopatias Congênitas/sangue , Cardiopatias Congênitas/diagnóstico , Ventrículos do Coração/anormalidades , Peptídeo Natriurético Encefálico/sangue , Disfunção Ventricular Direita/sangue , Disfunção Ventricular Direita/congênito , Adolescente , Adulto , Biomarcadores/sangue , Criança , Estudos de Coortes , Progressão da Doença , Ecocardiografia Transesofagiana , Eletrocardiografia Ambulatorial , Tolerância ao Exercício/fisiologia , Feminino , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/cirurgia , Testes de Função Cardíaca , Humanos , Masculino , Peptídeo Natriurético Encefálico/análise , Probabilidade , Estudos Retrospectivos , Sensibilidade e Especificidade , Taxa de Sobrevida , Disfunção Ventricular Direita/diagnósticoRESUMO
OBJECTIVE: To evaluate the utility of plasma BNP measurement in the long term follow-up of patients with surgically repaired tetralogy of Fallot (TOF). METHODS: From 2002 to 2008, plasma BNP concentration was measured in 130 patients with TOF at the age of mean 16.1+/-7.1 years and mean 13.0+/-6.5 years after surgically repair. BNP levels were compared to age and gender-specific normal values, results of exercise testing, clinical, electrocardiographic, and echocardiographic data. RESULTS: BNP was <200 pg/ml in all and elevated in 60% of patients. Higher values were found in females (p=0.001), in patients waiting for pulmonary valve replacement (p<0.001), and in NYHA class II compared to NYHA I patients (p=0.012) with an inverse correlation between BNP and exercise time (r=-0.59, p<0.001). BNP was correlated with right ventricular dilatation (r=0.29, p=0.005) and severity of both tricuspid (r=0.22, p=0.015) and pulmonary regurgitation (r=0.20, p=0.029). Longitudinal data revealed increasing BNP levels before (p=0.04) and a BNP decrease after pulmonary valve replacement (p=0.03), but no change in patients without surgery. CONCLUSIONS: In patients with surgically repaired TOF, plasma BNP is significantly correlated with right ventricular volume load. In clinical practice a considerable overlap limits the estimation of right ventricular volume load by BNP, but longitudinal evaluation helps to appoint the appropriate timing of pulmonary valve replacement.
Assuntos
Biomarcadores/sangue , Peptídeo Natriurético Encefálico/sangue , Insuficiência da Valva Pulmonar/sangue , Tetralogia de Fallot/sangue , Tetralogia de Fallot/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Ecocardiografia , Eletrocardiografia , Teste de Esforço , Feminino , Seguimentos , Humanos , Masculino , Insuficiência da Valva Pulmonar/diagnóstico , Insuficiência da Valva Pulmonar/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tetralogia de Fallot/diagnóstico , Função Ventricular Direita , Adulto JovemRESUMO
BACKGROUND: B-type natriuretic peptide (BNP) and the N-terminal fragment of proBNP (NT-proBNP) seem to be useful diagnostic tools also in children with cardiac disease. Recent data suggest that plasma levels of both peptides show different patterns from infancy to adolescence. AIM: To investigate the relationship of BNP and NT-proBNP in children and adolescents according to age. SUBJECTS AND METHODS: In 46 individuals without cardiac disease (22 males, 24 females, aged 0.4-17.5 years) and 30 patients with congenital heart disease (17 males, 13 females, aged 0.2-18.4 years), plasma levels of BNP and NT-proBNP were measured in the same sample (triage BNP assay, Biosite and Elecsys NT-proBNP assay, Roche Diagnostics). RESULTS: The range of BNP plasma levels was 5-32 pg/ml in individuals without heart disease and 5-1300 pg/ml in the patient group, the range of NT-proBNP was 10-298 pg/ml and 30-18,966 pg/ml, respectively. In both groups, the ratio NT-proBNP/BNP decreased with increasing age (P<0.001). CONCLUSION: Although proBNP is cleaved into the two fragments NT-proBNP and BNP, there is a decreasing ratio of NT-proBNP/BNP with increasing age caused probably by age-dependent differences in the metabolic clearance of both peptides. This has to be considered in comparison studies on BNP and NT-proBNP regarding their benefit to paediatric cardiology.