The relationship of systemic right ventricular function to ECG parameters and NT-proBNP levels in adults with transposition of the great arteries late after Senning or Mustard surgery.
OBJECTIVE
Heart failure is common late after Senning or Mustard palliation of transposition of the great arteries (TGA). Although cardiac magnetic resonance (CMR) is the gold standard for evaluating systemic right ventricular performance, additional information regarding heart failure status might be gleaned from the surface ECG and circulating N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. The interrelationships between these heart failure markers were examined in adults late after Mustard and Senning surgery.


METHODS
Thirty-five consecutive adults with Senning or Mustard repair of TGA attending a dedicated congenital heart failure clinic were studied. Assessment included symptom assessment, venous blood sampling for measurement of circulating NT-proBNP levels, surface 12-lead ECG and CMR for the assessment of right ventricular systolic function and determination of indexed right ventricular volumes.


RESULTS
Mean age was 29 ± 6.5 years, 54% had undergone Mustard surgery. Compared with those with uncomplicated surgery, patients with complex surgical history had higher NT-proBNP levels (55 ± 26 vs 20 ± 35 pmol/l; p=0.002) and longer QRS duration (116 ± 28 ms vs 89 ± 11 ms; p=0.0004) while showing no difference in New York Heart Association class and right ventricular function. There was a significant relationship between diastolic and systolic right ventricular volumes and both NT-proBNP levels (r=0.43, p=0.01; r=0.53, p=0.001, respectively) and QRS duration (r=0.47, p=0.004; r=0.53, p=0.001, respectively).


CONCLUSIONS
Circulating NT-proBNP levels and several surface ECG parameters constitute safe, cost-effective and widely available surrogate markers of systemic right ventricular function and provide additional information on heart failure status. Both measures hold promise as prognostic markers and their association with long-term outcome should be determined.
Plymen
Carla M
CM
The Division of Adult Congenital Heart Disease, The Heart Hospital, University CollegeLondon Hospitals NHS Foundation Trust, London, UK. carla.plymen@uclh.nhs.uk
Hughes
Marina L
ML
Picaut
Nathalie
N
Panoulas
Vasileios F
VF
Macdonald
Simon T
ST
Cullen
Seamus
S
Deanfield
John E
JE
Walker
Fiona
F
Taylor
Andrew M
AM
Lambiase
Pier D
PD
Bolger
Aidan P
AP
D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008133:Long QT Syndrome / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D010166:Palliative Care / Q000379:methods; D010446:Peptide Fragments / Q000378:metabolism*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D011379:Prognosis; D013318:Stroke Volume; D014188:Transposition of Great Vessels / Q000503:physiopathology / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000503:physiopathology; D055815:Young Adult
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain