Clinical Research
Biomarkers
N-Terminal Pro-B-Type Natriuretic Peptide and Its Relationship With Cardiac Function in Adults With Congenital Heart Disease

https://doi.org/10.1016/j.jacc.2013.07.019Get rights and content
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Objectives

The aim of this study was to determine the value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in adults with congenital heart disease (CHD) and investigate its relationship with ventricular function and exercise capacity.

Background

NT-proBNP may detect early deterioration in cardiac function.

Methods

In this cross-sectional study, extensive echocardiography, exercise testing, and NT-proBNP measurements were performed on the same day in consecutive adult patients with CHD.

Results

In total, 475 patients were included in this study (mean age of 34 ± 12 years, 57% male, 90% New York Heart Association class I). The median NT-proBNP level was 15.1 pmol/l (interquartile range [IQR]: 7.1 to 31.3 pmol/l), and the NT-proBNP level was >14 pmol/l in 53% of patients. The highest NT-proBNP levels were observed in patients with Fontan circulation (36.1 pmol/l [IQR: 14.4 to 103.8 pmol/l]) and a systemic right ventricle (RV) (31.1 pmol/l [IQR: 21.8 to 56.0 pmol/l]), and the lowest values were seen in patients with aortic coarctation (7.3 pmol/l [IQR: 2.8 to 19.5 pmol/l]). NT-proBNP levels correlated with age (r = 0.39, p < 0.001) and were higher in women (median of 21.7 vs. 10.4 pmol/l; p < 0.001). In patients with aortic stenosis or aortic coarctation, NT-proBNP levels correlated with diastolic function parameters of E/E′ ratio (r = 0.40, p < 0.001) and left atrial dimension (r = 0.36, p < 0.001). In patients with a systemic RV, NT-proBNP levels correlated with RV annulus diameter (r = 0.31, p = 0.024). In patients with tetralogy of Fallot, the strongest correlations were observed with left atrial dimension (r = 0.46, p < 0.001) and left ventricular ejection fraction (r = 0.37, p < 0.001). NT-proBNP levels were associated with exercise capacity (n = 198) (maximum workload: β = −0.08, p = 0.021) and peak oxygen uptake (β = −0.012, p = 0.011) in a multivariable regression model adjusted for age and sex.

Conclusions

NT-proBNP levels in adults with CHD clearly differ by diagnosis and are related to echocardiographic parameters and exercise capacity. Disease-specific correlations contribute to the understanding of the main hemodynamic problems per diagnosis. Follow-up data are needed to elucidate the additional prognostic value.

Key Words

congenital heart disease
exercise test
NT-proBNP
2-dimensional echocardiography

Abbreviations and Acronyms

AoS
aortic valvular stenosis
ASO
arterial switch operation
CHD
congenital heart disease
CoA
aortic coarctation
FAC
fractional area change
IQR
interquartile range
LV
left ventricle
NT-proBNP
N-terminal pro-B-type natriuretic peptide
NYHA
New York Heart Association
RV
right ventricle
TGA
transposition of the great arteries
ToF
tetralogy of Fallot
Vo2max
maximal oxygen uptake
workloadmax
maximal exercise capacity

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The authors have reported that they have no relationships relevant to the content of this paper to disclose.