title: N-terminal pro-B-type natriuretic peptide and its relationship with cardiac function in adults with congenital heart disease.
abstract: OBJECTIVE
  The aim of this study was to determine the value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in adults with congenital heart disease (CHD) and investigate its relationship with ventricular function and exercise capacity.
  
  
  BACKGROUND
  NT-proBNP may detect early deterioration in cardiac function.
  
  
  METHODS
  In this cross-sectional study, extensive echocardiography, exercise testing, and NT-proBNP measurements were performed on the same day in consecutive adult patients with CHD.
  
  
  RESULTS
  In total, 475 patients were included in this study (mean age of 34 ± 12 years, 57% male, 90% New York Heart Association class I). The median NT-proBNP level was 15.1 pmol/l (interquartile range [IQR]: 7.1 to 31.3 pmol/l), and the NT-proBNP level was >14 pmol/l in 53% of patients. The highest NT-proBNP levels were observed in patients with Fontan circulation (36.1 pmol/l [IQR: 14.4 to 103.8 pmol/l]) and a systemic right ventricle (RV) (31.1 pmol/l [IQR: 21.8 to 56.0 pmol/l]), and the lowest values were seen in patients with aortic coarctation (7.3 pmol/l [IQR: 2.8 to 19.5 pmol/l]). NT-proBNP levels correlated with age (r = 0.39, p < 0.001) and were higher in women (median of 21.7 vs. 10.4 pmol/l; p < 0.001). In patients with aortic stenosis or aortic coarctation, NT-proBNP levels correlated with diastolic function parameters of E/E' ratio (r = 0.40, p < 0.001) and left atrial dimension (r = 0.36, p < 0.001). In patients with a systemic RV, NT-proBNP levels correlated with RV annulus diameter (r = 0.31, p = 0.024). In patients with tetralogy of Fallot, the strongest correlations were observed with left atrial dimension (r = 0.46, p < 0.001) and left ventricular ejection fraction (r = 0.37, p < 0.001). NT-proBNP levels were associated with exercise capacity (n = 198) (maximum workload: β = -0.08, p = 0.021) and peak oxygen uptake (β = -0.012, p = 0.011) in a multivariable regression model adjusted for age and sex.
  
  
  CONCLUSIONS
  NT-proBNP levels in adults with CHD clearly differ by diagnosis and are related to echocardiographic parameters and exercise capacity. Disease-specific correlations contribute to the understanding of the main hemodynamic problems per diagnosis. Follow-up data are needed to elucidate the additional prognostic value.
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Jannet A
authors.initials: JA
authors.lastname: Eindhoven
authors.forename: Annemien E
authors.initials: AE
authors.lastname: van den Bosch
authors.forename: Titia P E
authors.initials: TP
authors.lastname: Ruys
authors.forename: Petra
authors.initials: P
authors.lastname: Opić
authors.forename: Judith A A E
authors.initials: JA
authors.lastname: Cuypers
authors.forename: Jackie S
authors.initials: JS
authors.lastname: McGhie
authors.forename: Maarten
authors.initials: M
authors.lastname: Witsenburg
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
mesh_terms: D000328:Adult; D003971:Diastole; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D013599:Systole; D055815:Young Adult
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: 2-dimensional echocardiography; ASO; AoS; CHD; CoA; FAC; IQR; LV; N-terminal pro-B-type natriuretic peptide; NT-proBNP; NYHA; New York Heart Association; RV; TGA; ToF; Vo(2max); aortic coarctation; aortic valvular stenosis; arterial switch operation; congenital heart disease; exercise test; fractional area change; interquartile range; left ventricle; maximal exercise capacity; maximal oxygen uptake; right ventricle; tetralogy of Fallot; transposition of the great arteries; workload(max)