The syndrome of cardiac failure in adults with congenitally corrected transposition.
OBJECTIVE
To assess neurohormonal activation of cardiac failure in adults with congenitally corrected transposition, and to determine the most sensitive marker for recognition of the cardiac failure.


BACKGROUND
The onset of morphologically right ventricular dysfunction is unpredictable in patients with congenitally corrected transposition, the combination of discordant atrioventricular and ventriculo-arterial connections, and its markers are unknown.


METHODS
We measured amino terminal pro brain natriuretic peptide in 19 patients, aged 35 plus or minus 13.1 years, and in 19 control subjects. Morhologically right ventricular function was assessed by echocardiography, including tissue Doppler echocardiography and magnetic resonance imaging or multislice computed tomography.


RESULTS
The patients showed a highly significant increase in the levels of amino terminal pro brain natriuretic peptide, the levels being significantly elevated even in asymptomatic patients. Left atrial dimensions were larger in patients, and significantly lower tissue Doppler echocardiographic velocities were measured at the lateral site of the tricuspid annulus and at the basal segment of the interventricular septum. The ejection fraction of the morphologically right ventricle correlated significantly with the levels of brain natriuretic peptide, and with left atrial dimensions.


CONCLUSIONS
Neurohormonal activation is present in patients with congenitally corrected transposition even when they are asymptomatic. It is correlated with left atrial dimensions and tissue Doppler echocardiographic parameters. Levels of brain natriuretic peptide, and peak tricuspid early diastolic annular velocity, are the earliest and most sensitive markers of morphologically right ventricular dysfunction.
Kozelj
Mirta
M
Department of Cardiology, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia. mirta.kozelj@mf.uni-lj.si
Prokselj
Katja
K
Berden
Pavel
P
Jan
Matevz
M
Osredkar
Josko
J
Bunc
Matjaz
M
Tretjak
Martin
M
Podnar
Tomaz
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D016022:Case-Control Studies; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D007118:Immunoassay; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D018377:Neurotransmitter Agents / Q000097:blood*; D011859:Radiography; D017524:Slovenia; D014188:Transposition of Great Vessels / Q000097:blood* / Q000000981:diagnostic imaging / Q000601:surgery; D016278:Ventricular Function, Right / Q000502:physiology; D055815:Young Adult
D015415:Biomarkers; D018377:Neurotransmitter Agents; D020097:Natriuretic Peptide, Brain