Brain natriuretic peptide as a biomarker of systemic right ventricular function in patients with transposition of great arteries after atrial switch operation.
BACKGROUND
Assessment of systemic right ventricular (RV) function is inherently difficult. In adults, plasma brain natriuretic peptide (BNP) level has been shown to reflect systemic ventricular dysfunction. We sought to test the hypothesis that plasma BNP is a biomarker of systemic RV function in patients after atrial switch operation.


METHODS
We determined the RV function in 44 patients, 35 after Senning and 9 after Mustard operation, aged 19.7+/-4.0 years, by tissue Doppler echocardiography and determination of myocardial performance index (MPI). The results were compared to the left ventricular function of 14 age-matched controls. Their plasma BNP levels were correlated with indices of systemic ventricular function.


RESULTS
Compared with controls, the patients had greater MPI (p<0.001), lower systemic ventricular free wall-annular early diastolic (p<0.001), late diastolic (p<0.001), and systolic velocities (p=0.001), lower septal-annular early diastolic (p<0.001), late diastolic (p<0.001), and systolic velocities (p<0.001), and higher BNP levels (p=0.03). Plasma BNP levels correlated positively with MPI (r=0.43, p=0.001) and negatively with the free wall- and septal-annular myocardial velocities (r=-0.32 to -0.47, p<0.05). The area under the receiver operating characteristic curve for BNP to detect ventricular dysfunction (MPI >0.45) in patients was 0.67 (p=0.04). A BNP level of 36 pg/ml had a sensitivity of 55%, specificity of 86%, positive predictive value 80%, negative predictive value of 64%, and an accuracy of 70% for detecting systemic ventricular dysfunction.


CONCLUSIONS
Plasma BNP has modest accuracy in the detection of systemic RV dysfunction in patients after atrial switch operation.
Chow
Pak-Cheong
PC
Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Grantham Hospital, The University of Hong Kong, 125 Wong Chuk Hang Road, Hong Kong, China.
Cheung
Eddie Wai-Yin
EW
Chong
Chun-Yin
CY
Lun
Kin-Shing
KS
Yung
Tak-Cheung
TC
Wong
Kin-Tak
KT
Chau
Adolphus Kai-Tung
AK
Cheung
Yiu-Fai
YF
D000328:Adult; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures; D016022:Case-Control Studies; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013599:Systole; D014188:Transposition of Great Vessels / Q000097:blood* / Q000000981:diagnostic imaging / Q000601:surgery; D018497:Ventricular Dysfunction, Right / Q000097:blood*
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain