title: Blood biomarkers and their potential role in pulmonary arterial hypertension associated with congenital heart disease. a systematic review.
abstract: BACKGROUND
  The development of pulmonary arterial hypertension (PAH) in patients with congenital heart disease (CHD) is multifactorial with a number of biomarkers serving as mediators of neurohormonal activation [B-type natriuretic peptide (BNP) and its N-terminal-pro-fragment (NT-proBNP)], endothelial dysfunction [asymmetric dimethylarginine (ADMA)] and cellular proliferation [vascular endothelial growth factor (VEGF)].
  
  
  METHODS
  We systematically reviewed the literature for trials studying the role of these biomarkers in the clinical evaluation, prognosis and management of patients with PAH related to CHD (CHD-PAH).
  
  
  RESULTS
  Twenty-six studies were included in the systematic review, involving a total of 1113 patients with CHD-PAH. These patients had higher BNP, NT-proBNP and ADMA levels and higher VEGF expression when compared with healthy controls. Baseline and serial values of plasma levels of natriuretic peptides were shown to be significant predictors of survival. ADMA concentration was elevated in patients with CHD-PAH when compared with patients with simple CHD without PAH, whereas VEGF expression was particularly high in patients with CHD and persistent PAH after corrective surgery of the underlying heart disease.
  
  
  CONCLUSIONS
  Right heart dysfunction, endothelial inflammation and proliferation are mirrored by plasma levels of the corresponding biomarkers among patients with CHD-PAH. There is early evidence to suggest that natriuretic peptides, in particular, may be a simple and effective tool for determining prognosis and timing for therapeutic interventions in patients with CHD-PAH.
authors.affiliation: First Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, St. Kyriakidi 1, 54636, Thessaloniki, Greece; Royal Brompton Biomedical Research Unit NIHR, National Heart and Lung Institute, Imperial College, London, United Kingdom. Electronic address: giannak@med.auth.gr.
authors.forename: George
authors.initials: G
authors.lastname: Giannakoulas
authors.affiliation: First Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, St. Kyriakidi 1, 54636, Thessaloniki, Greece.
authors.forename: Sophia-Anastasia
authors.initials: SA
authors.lastname: Mouratoglou
authors.affiliation: Royal Brompton Biomedical Research Unit NIHR, National Heart and Lung Institute, Imperial College, London, United Kingdom.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gatzoulis
authors.affiliation: First Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, St. Kyriakidi 1, 54636, Thessaloniki, Greece.
authors.forename: Haralambos
authors.initials: H
authors.lastname: Karvounis
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D006330:Heart Defects, Congenital / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011446:Prospective Studies; D012189:Retrospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000097:blood
chemical_list: D015415:Biomarkers; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D020097:Natriuretic Peptide, Brain
keywords: Asymmetric dimethylarginine; Brain natriuretic peptide; Congenital heart disease; Endothelial dysfunction; Pulmonary hypertension; Vascular endothelial growth factor