Residual echocardiographic findings and NT-proBNP in asymptomatic adult patients after radical correction of Fallot’s tetralogy


Authors: T. Zatočil;  J. Maňoušek;  T. Brychta;  A. Nečasová;  J. Špinar
Authors‘ workplace: Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC
Published in: Vnitř Lék 2007; 53(2): 116-122
Category: Original Contributions

Overview

Objective:
Define the profile of NT-proBNP values in asymptomatic adult patients after radical correction of Tetralogy of Fallot (TOF) and identify links between possible increase in NT-proBNP and residual echocardiographic findings.

Methodology:
NT-proBNP samples were taken from and a detailed echocardiographic examination was performed in 21 adult stabilised patients after radical correction of TOF in childhood. The results were submitted for statistical analysis.

Results:
The incidence of low values of the S wave < 11.5 cm/s of tricuspid anulus evaluated by tissue Doppler echocardiography (TDI) (P < 0.05) was significantly higher in patients with NT-proBNP > 125 pg/ml. All patients with impaired right ventricular diastolic filling evaluated by tissue Doppler echocardiography (E’ / A’ < 1) had higher values of NT-proBNP (NS). Other echocardiographic parametres did not show any dependence on NT-proNBP values, including the morphology or atrial defects in the right heart sections which are most conspicuous in an echocardiographic examination.

Conclusion:
Asymptomatic patients after radical correction of TOF have higher values of NT-proBNP (167.95 ± 91.75 pg/ml). At the same time, the increase closely correlates with the detection of a global right ventricle systolic dysfunction evaluated by S (TDI). On the other hand, there is often no correlation between highly conspicuous changes in the morphology of the right heart compartments or residual or postincision defects of the pulmonary valve on the one hand and increased NT-proBNP on the other. The S measurement has the potential to become routine examination in patients after radical correction of TOF for timely detection of right ventricular systolic dysfunction. Precise prognostic and primarily therapeutic impact of the pathologic finding still needs to be determined.

Key words:
Fallot’s tetralogy – tissue Doppler echocardiography – echocardiography – NT – proBNP


Sources

1. Piran S, Veldtman G, Siu S et al. Heart failure and ventricular dysfunction in patients with single or systemic right ventricle. Circulation 2002; 105: 1189-1194.

2. Bolger AP, Sharma R, Li W et al. Neurohormonal activation and the chronic heart failure syndrome in adults with congenital heart disease. Circulation 2002; 106: 92-99.

3. Law YM, Keller BB, Feingold BM et al. Usefulness of plasma B-type natriuretic peptide to identify ventricular dysfunction in pediatric and adult patients with congenital heart disease. Am J Cardiol 2005; 95: 474-478.

4. Brili S, Alexopoulos N, Latsios G et al. Tissue Doppler Imaging and Brain Natriuretic Peptide Levels in Adults with Repaired Tetralogy of Fallot. J of Am Soc of Echo 2005.

5. Oosterhof T, Tulevski II, Vliegen HW et al. Effects of Volume and/or Pressure Overload Secondary to Congenital Heart Disease (Tetralogy of Fallot or Pulmonary Stenosis) on Right Ventricular Function Using Cardiovascular Magnetic Resonance and Brain Natriuretic Peptide Levels. Am J Cardiol 2006; 97: 1051-1055.

6. Troughton RW, Prior DL, Pereira JJ et al. Plasma B-Type Natriuretic Peptide Levels in Systolic Heart Failure, Importance of Left Ventricular Diastolic Function and Right Ventricular Systolic Function. J Am Coll Card 2003; 3: 416-422.

7. Ishii H, Harada K, Toyono M et al. Usefulness of Exercise-Induced Changes in Plasma Levels of Brain Natriuretic Peptide in Predicting Right Ventricular Contractile Reserve After Repair of Tetralogy of Fallot. Am J Cardiol 2005; 95: 1338-1343.

8. Roest AAW, Helbing WA, Kunz P et al. Exercise MR Imaging in the Assessment of Pulmonary Regurgitation and Biventricular Function in Patients after Tetralogy of Fallot Repair. Radiology 2002; 223: 204-211.

9. Perloff JK, Child JS. Congenital Heart Disease in Adults. 2nd ed. Philadelphia: WB Saunders 1998.

10. Popelová J. Vrozené srdeční vady v dospělosti. Praha: Grada 2003.

11. Marek J. Echokardiografie. 2. díl - Pediatrická a prenatální echokardiografie. Praha: Triton 2003.

12. Špirková Z, Daňová K, Pecháň I et al. Kardiomarkery. Bratislava: Phonec Agency 2003.

13. BNP Consensus Panel 2004. Congestive Heart Failure 2004; 10(5; Suppl 3): 1-30.

14. Meluzín J, Špinarová L, Bakala J et al. Pulsed Doppler tissue imaging of the velocity of tricuspid annular systolic motion. Eur Heart J 2001; 4: 340-348.

15. Špinarová L, Toman J. Humorální změny u chronického srdečního selhání. Cor Vasa 2001; 43: 513-519.

16. Málek F. Natriuretické peptidy. Remedia 2002; 12: 146-150.

17. Vítovec J, Špinarová L. Natriuretické peptidy - diagnostika a léčba. Remedia 2004; 14: 177-181.

18. Staněk V. Kardiologie a biochemie. Znamenají natriuretické peptidy novou éru v diagnostice a kontrole léčby srdečního selhání? Cor Vasa 2002; 44: 504-505.

19. Hradec J. Mohou se stát natriuretické peptidy křišťálovou koulí kardiologa? JACC-CZ 2003; 5: 255-257.

20. Stejskal D, Oral I, Lačňák B et al. Vlastní zkušenosti s využitím stanovení NT-proBNP v klinické praxi. Vnitřní Lék 2003; 49: 121-126.

21. Kluh T, Jabor A, Pavlisová M. Vztah natriuretických peptidů (BNP, NT-proBNP) k celkové mortalitě. Čtyřleté sledování souboru nemocných. Vnitřní Lék 2003; 49: 551-554.

22. Hrazdira I, Kotulánová E, Maryšková V. Barevné dopplerovské metody a jejich diagnostický význam. Vnitř Lék 2003; 49: 563-566.

23. Mariano-Goulart D, Eberle MC, Boudousq V et al. Major increase in brain natriuretic peptide indicates right ventricular systolic dysfunction in patient with heart failure. Eur J Heart Failure 2003; 107: 1278-1283.

24. Oral I. Natriuretické peptidy - současný stav klinického využití jejich stanovení. Vnitř Lék 2003; 49: 521-523.

25. Stejskal D, Lačňák B, Oral I et al. Mozkový natriuretický peptid (natriuretický peptid B, BNP). Prakt Lék 2003; 83: 76-78.

26. Rushmer RF, Crystal DK, Wagner C. The functional anatomy of ventricular contraction. Circulation Research 1953; 1: 162-170.

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Diabetology Endocrinology Internal medicine
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