title: NT-proBNP Indicates Left Ventricular Impairment and Adverse Clinical Outcome in Patients With Tetralogy of Fallot and Pulmonary Regurgitation.
abstract: The goal of this study was to interrelate N-terminal B-type natriuretic peptide (NT-proBNP) levels and cardiac magnetic resonance imaging-derived ventricular function, mass, and volumes in adults with pulmonary regurgitation after Fallot repair and to evaluate the prognostic relevance of these parameters regarding adverse clinical outcome.
  
  
  
  Eighty-one patients (aged 26.3 ± 7.4 years; male sex, 45.7%; New York Heart Association class I, 72.8%; pulmonary valve velocity, < 3 m/s) were included. At baseline cardiac magnetic resonance imaging and NT-proBNP measurements were performed.
  
  
  
  During a mean observation time of 6.9 ± 2.6 years, 13 patients (16.1%) had sustained supraventricular arrhythmias or heart failure (2.4 per 100 patient-years). Multivariate Cox analysis identified NT-proBNP, left ventricular (LV) end-systolic volume index and LV ejection fraction, right ventricular (RV) end-diastolic volume index, and tricuspid regurgitation as independent predictors of adverse events. NT-proBNP correlated with LV but not with RV parameters. In receiver operating characteristic curve analysis using significant variables of the multivariate analysis, NT-proBNP was superior to all other parameters to detect patients at risk (area under the curve [AUC], 0.873; 95% confidence interval, 0.772-0.974). LV end-systolic volume index (AUC, 0.734), RV end-diastolic volume index (AUC, 0.645) und tricuspid regurgitation (AUC, 0.747) showed lower diagnostic accuracy.
  
  
  
  Even in mildly symptomatic patients with pulmonary regurgitation after Fallot repair NT-proBNP is a strong predictor of adverse outcome. It is rather associated with LV but not with RV impairment. In severe pulmonary regurgitation an increase in the level of NT-proBNP and LV impairment seem to provide additional useful information for the timing of pulmonary valve replacement.
authors.affiliation: Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany. Electronic address: Westhoff-Bleck.Mechthild@MH-Hannover.de.
authors.forename: Mechthild
authors.initials: M
authors.lastname: Westhoff-Bleck
authors.affiliation: Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
authors.forename: Finn
authors.initials: F
authors.lastname: Kornau
authors.affiliation: Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
authors.forename: Arash
authors.initials: A
authors.lastname: Haghikia
authors.affiliation: Department of Cardiothoracic Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Horke
authors.affiliation: Department of Paediatric Cardiology and Paediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Bertram
authors.affiliation: Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Treptau
authors.affiliation: Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Widder
authors.affiliation: Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
authors.forename: Johann
authors.initials: J
authors.lastname: Bauersachs
authors.affiliation: Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
authors.forename: Michael-Ulrich
authors.initials: MU
authors.lastname: Brehm
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D011665:Pulmonary Valve Insufficiency / Q000150:complications* / Q000601:surgery; D013318:Stroke Volume; D013599:Systole; D013617:Tachycardia, Supraventricular / Q000209:etiology; D013771:Tetralogy of Fallot / Q000150:complications* / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000209:etiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain