title: The cause of B-type natriuretic peptide elevation and the dose-dependent effect of angiotensin-converting enzyme inhibitor on patients late after tetralogy of Fallot repair.
abstract: Patients after surgical repair of tetralogy of Fallot (TOF) may experience various complications that result in neurohormonal activation, including plasma B-type natriuretic peptide (BNP) elevation. Right ventricular (RV) dilation is a frequent complication, and few treatments are available. This study aimed to identify the factor or factors leading to BNP elevation and to clarify the effects of angiotensin-converting enzyme inhibitor (ACE-I) on changes in BNP levels in patients with repaired TOF. Plasma BNP levels and hemodynamic data derived from cardiac catheterization were analyzed. In addition, longitudinal BNP levels and ACE-I dosages were analyzed for patients administered ACE-I. For 31 patients with repaired TOF, who mainly had RV dilation, log BNP levels were significantly correlated with the RV end-diastolic volume index (P = 0.02) as well as ventricular volume and pressure (P < 0.01). For 11 patients medicated with ACE-I, BNP levels were significantly lower at the time of maximal ACE-I dosage than at the time of minimal dosage (P < 0.01). Furthermore, BNP levels decreased as the ACE-I dosage per body weight increased (P < 0.01). In conclusion, elevation of BNP in patients after TOF repair could reflect volume and pressure load in the RV end-diastolic phase, and ACE-I may reduce BNP levels in a dose-dependent manner.
authors.affiliation: Department of Pediatrics, Hokkaido University Hospital, Kita-ku, Sapporo City, Hokkaido, Japan. furutaku@med.hokudai.ac.jp
authors.forename: Takuo
authors.initials: T
authors.lastname: Furukawa
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Murakami
authors.forename: Michihiko
authors.initials: M
authors.lastname: Ueno
authors.forename: Atsuhito
authors.initials: A
authors.lastname: Takeda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yakuwa
authors.forename: Hirokuni
authors.initials: H
authors.lastname: Yamazawa
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000097:blood / Q000503:physiopathology* / Q000601:surgery; D013997:Time Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D020097:Natriuretic Peptide, Brain