title: N-terminal probrain natriuretic peptide level inversely correlates with cardiac index after arterial switch operation in neonates.
abstract: BACKGROUND
  Natriuretic peptide levels are associated with cardiac output and ventricular function. We hypothesized that concomitant measurement of the peptide fragments and the hemodynamic parameters could elucidate the associations of these parameters after pediatric cardiac surgery.
  
  
  METHODS
  After approval of the institutional review board and parents' informed consent, we investigated the clinical data of eight neonates undergoing correction of transposition of the great arteries. We measured the level of N-terminal fragments of prohormones of atrial and brain natriuretic peptides (NT-proANP, NT-proBNP) preoperatively, postoperatively and 12, 24, 48, and 72 h after arrival in the intensive care unit. The hemodynamic status was assessed by transpulmonary thermodilution at the same time points. Creatinine and other laboratory values were analyzed in the first 48 h postoperatively.
  
  
  RESULTS
  NT-proBNP levels were inversely correlated with cardiac index (CI, r = -0.47, P = 0.030), stroke volume index (r = -0.65, P = 0.005), and global end-diastolic volume index (GEDI; r = -0.63, P = 0.011). There was strong inverse correlation between the change of NT-proBNP levels and the change of CI between two consecutive measurements during the postoperative period (r = -0.79, P = 0.001). The NT-proBNP level 12 h after surgery was strongly correlated with the creatinine level of the postoperative 24th hour (r = 0.81, P = 0.014).
  
  
  CONCLUSIONS
  NT-proBNP correlated with the hemodynamic parameters and with the severity of renal dysfunction. Therefore, NT-proBNP is a reliable indicator of the circulatory state and the severity of a low output syndrome after arterial switch operation in neonates.
authors.affiliation: Research Department, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary.
authors.forename: Tamás
authors.initials: T
authors.lastname: Breuer
authors.forename: Erzsébet
authors.initials: E
authors.lastname: Sápi
authors.forename: Réka
authors.initials: R
authors.lastname: Skoumal
authors.forename: Miklós
authors.initials: M
authors.lastname: Tóth
authors.forename: Minna
authors.initials: M
authors.lastname: Ala-Kopsala
authors.forename: Olli
authors.initials: O
authors.lastname: Vuolteenaho
authors.forename: Juhani
authors.initials: J
authors.lastname: Leppäluoto
authors.forename: Heikki
authors.initials: H
authors.lastname: Ruskoaho
authors.forename: András
authors.initials: A
authors.lastname: Szatmári
authors.forename: Andrea
authors.initials: A
authors.lastname: Székely
mesh_terms: D002302:Cardiac Output; D006801:Humans; D007231:Infant, Newborn; D016014:Linear Models; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011184:Postoperative Period; D013815:Thermodilution; D014188:Transposition of Great Vessels / Q000097:blood / Q000601:surgery*
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain