title: Prognostic value of NT-proBNP in patients with systemic morphological right ventricles: a single-centre experience.
abstract: In systemic morphological right ventricles after atrial redirection surgery, NT-proBNP is correlated with NYHA-class, ventricular function and subaortic AV-valve regurgitation (TR). The impact of NT-proBNP on adverse clinical outcomes is, however, unknown.
  
  
  METHODS
  This prospectively designed, longitudinal, observational study evaluated NT-proBNP in 116 patients (24.9 ± 4.2 years old, NYHA class I/II/III=97/18/1, 71 men) relative to all cardiac causes of hospitalisation, heart failure, transplantation and death.
  
  
  RESULTS
  The mean observation time was 7.3 ± 2.4 years. In univariate Cox proportion analysis, the predictors for all causes of hospitalisation (n=41; 35.5%) were NT-proBNP (HR: 5.99; 95%CI: 3.21-11.18), NYHA class (HR: 2.98; 95%CI: 1.62-5.5), ventricular function (HR: 1.96; 95%CI: 1.27-3.02), TR (HR: 2.39; 95%CI: 1.48-3.59), ventricular septal defect repair (HR: 1.29; 95%CI: 1.08-1.53) and a history of supraventricular tachycardia (SVT) (HR: 7.13; 95%CI: 3.74-13.59). In multivariate Cox proportion analysis, NT-proBNP (HR: 3.71; 95%CI: 1.82-7.57), SVT (HR: 4.27; 95%CI: 2.03-8.94) and ventricular septal defect repair (HR: 1.41; 95%CI: 1.15-1.72) remained independently associated with all causes of hospitalisation. For heart failure, transplantation and death, the single predictors were NT-proBNP (HR: 20.67; 95%CI: 4.69-91.78), NYHA class (HR: 6.45; 95%CI: 2.75-15.14), ventricular function (HR: 2.70; 95%CI: 1.48-4.92), TR (HR: 4.11; 95%CI: 1.99-8.47), QRS duration (HR: 2.09; 95%CI: 1.06-4.12) and SVT (HR: 8.00; 95%CI: 2.82-22.69). Multivariate Cox proportion analysis identified NT-proBNP (HR: 6.82; 95%CI: 1.32-35.04) and NYHA class (HR: 6.79; 95%CI: 1.75-26.28). Using ROC curves, the ability of NT-proBNP to detect patients at risk was greater for heart failure, transplantation and death (AUC: 0.944; 95%CI: 0.900-0.988) than for all causes of hospitalisation (AUC: 0.8; 95%CI: 0.713-0.887).
  
  
  CONCLUSIONS
  In systemic right ventricles, NT-proBNP is a useful risk predictor for all causes of hospitalisation and, in particular, for heart failure, transplantation and death. It therefore might be a useful tool for risk assessment in this patient population.
authors.affiliation: Department of Cardiology and Angiology, Hannover Medical School, Germany. Electronic address: Westhoff-Bleck.Mechthild@MH-Hannover.de.
authors.forename: Mechthild
authors.initials: M
authors.lastname: Westhoff-Bleck
authors.forename: Edith
authors.initials: E
authors.lastname: Podewski
authors.forename: Oktay
authors.initials: O
authors.lastname: Tutarel
authors.forename: Daniela
authors.initials: D
authors.lastname: Wenzel
authors.forename: Christian
authors.initials: C
authors.lastname: Cappello
authors.forename: Harald
authors.initials: H
authors.lastname: Bertram
authors.forename: Johann
authors.initials: J
authors.lastname: Bauersachs
authors.forename: Julian
authors.initials: J
authors.lastname: Widder
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D018572:Disease-Free Survival; D018618:Echocardiography, Doppler, Color / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging* / Q000401:mortality; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D016037:Single-Blind Method; D055815:Young Adult
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Atrial switch; Hospitalisation; NT-proBNP; Systemic right ventricle