title: NT-proBNP as Marker of Ventricular Dilatation and Pulmonary Regurgitation After Surgical Correction of Tetralogy of Fallot: A MRI Validation Study.
abstract: The goal of this study is to evaluate whether NT-proBNP plasma levels may help as a screening biomarker for monitoring right ventricular dilatation, pulmonary regurgitation and the onset of heart failure in patients with repaired Tetralogy of Fallot. Our single-centre observational prospective study involved 43 patients (15.1 years, SD = 8) with corrected Tetralogy of Fallot. Data collection included: clinical parameters (electrocardiogram, chest X-ray, NYHA scale, time since last surgery), biochemistry (NT-proBNP levels) and MRI values (ventricular volumetry, pulmonary flow assessment). Mean time since last surgery was 13.5 years (SD = 7.8). There was a statistically significant correlation between the NT-proBNP levels (187.4 pg/ml, SD = 154.9) and right ventricular dilatation for both the right ventricular end-diastolic volume (124.9 ml/m2, SD = 31.2) (Pearson = 0.19, p < 0.01) and end-systolic volume (56.1 ml/m2, SD = 18.8) (Pearson = 0.21, p < 0.01) and also with the pulmonary regurgitation fraction (36.5%, SD = 16, Pearson = 0.12, p < 0.01). No significant correlation was found between NT-proBNP and right ventricular ejection fraction (54.6%, SD = 10.6, Pearson = -0.07), left ventricular ejection fraction (59.9%, SD = 7.1, Pearson = -0.18) or any clinical parameters. The receiver operating curve analysis evidenced that a NT-proBNP cut-off value above 133.2 pg/ml predicted the presence of dilated right ventricular end-diastolic and end-systolic volumes over centile 95 (sensitivity 82 and 83% and specificity 93 and 79%, respectively). In conclusion, in patients with surgically corrected Tetralogy of Fallot, NT-proBNP levels correlate with right ventricular dilatation and the degree of pulmonary regurgitation. Ambulatory determination of NT-proBNP might be an easy, readily available and cost-effective alternative for MRI follow-up evaluation of these patients.
authors.affiliation: Paediatric Cardiology Unit, Hospital Virgen del Rocio, Seville, Spain.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Paolino
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St. Thomas' Hospital, King's College London, London, UK.|Department of Paediatrics, Southwestern Medical Center, University of Texas, Dallas, TX, USA.
authors.forename: Tarique
authors.initials: T
authors.lastname: Hussain
authors.affiliation: Neonate Intensive Care Unit, Hospital Virgen del Rocio, Seville, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pavon
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St. Thomas' Hospital, King's College London, London, UK.
authors.forename: Maria Nieves
authors.initials: MN
authors.lastname: Velasco
authors.affiliation: Radiology Department and Biomedical Imaging Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Sergio
authors.initials: S
authors.lastname: Uribe
authors.affiliation: Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Hospital Virgen del Rocio/CSIC/University of Seville, Avda. Manuel Siurot, s/n, 41013, Seville, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ordoñez
authors.affiliation: Paediatric Cardiology Unit, Hospital Virgen del Rocio, Seville, Spain. ivalverde-ibis@us.es.|Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St. Thomas' Hospital, King's College London, London, UK. ivalverde-ibis@us.es.|Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Hospital Virgen del Rocio/CSIC/University of Seville, Avda. Manuel Siurot, s/n, 41013, Seville, Spain. ivalverde-ibis@us.es.
authors.forename: Israel
authors.identifier: http://orcid.org/0000-0001-5661-9900
authors.initials: I
authors.lastname: Valverde
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002648:Child; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D011665:Pulmonary Valve Insufficiency / Q000097:blood* / Q000000981:diagnostic imaging; D012372:ROC Curve; D013318:Stroke Volume; D013771:Tetralogy of Fallot / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000097:blood* / Q000000981:diagnostic imaging; D055815:Young Adult
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Congenital heart disease; Magnetic resonance imaging; NT-proBNP; Tetralogy of Fallot