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Does N-terminal pro-brain natriuretic peptide correlate with measured shunt fraction in children with septal defects?*

  • Abdullah Ozyurt (a1), Ali Baykan (a1), Mustafa Argun (a1), Ozge Pamukcu (a1), Kazim Uzum (a1), Figen Narin (a2) and Nazmi Narin (a1)...

Abstract

Background

The aim of this study was to investigate the potential role of N-terminal pro-brain natriuretic peptide in the assessment of shunt severity and invasive haemodynamic parameters in children with atrial septal defects and ventricular septal defects.

Methods

This is a prospective, controlled (n:62), observational study. Correlation analysis was performed between N-terminal pro-brain natriuretic peptide levels and various invasive haemodynamic measurements in 127 children (ventricular septal defect: 64; atrial septal defect: 63). A ratio of pulmonary to systemic blood flow (Qp/Qs⩾1.5) was considered to indicate a significant shunt.

Results

Statistically significant relationship was found between the mean N-terminal pro-brain natriuretic peptide values of the patients, with Qp/Qs⩾1.5 in both defect types and control group. For ventricular septal defect, N-terminal pro-brain natriuretic peptide level⩾113.5 pg/ml was associated with high specificity and sensitivity for determining the significant shunt. In addition, the cut-off point for determining the significant shunt for atrial septal defect was 57.9 pg/ml. Significant positive correlation was found between all invasive haemodynamic parameters and N-terminal pro-brain natriuretic peptide levels in patients with ventricular septal defects. Whereas significant positive correlation was found only between mean pulmonary artery pressure, right ventricular end-diastolic pressure, and systemic pressure to pulmonary pressure ratio and N-terminal pro-brain natriuretic peptide levels in patients with atrial septal defects.

Conclusion

Our study demonstrated that the N-terminal pro-brain natriuretic peptide measurements could be used as a supporting parameter in determining significance of the shunt.

Copyright

Corresponding author

Correspondence to: A. Ozyurt, MD, Department of Pediatric Cardiology, Erciyes University Medical Faculty, 38039 Kayseri, Turkey. Tel: +90 352 207 6666, ext. 25036; Fax: +90 324 223 0722; E-mail: duruozyurt@yahoo.com.tr

Footnotes

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*

The present study has been presented for Oral Presentation at the 48th Annual Meeting of the Association for European Paediatric and Congenital Cardiology, Helsinki, 21–24 May, 2014.

Footnotes

References

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1. Moss, AJ, Adams, FH. Heart Disease in Infants, Children, and Adolescents Including the Fetus and Young, 7th edn. Williams & Wilkins, Baltimore, MD, 2008: 632644; 667–681.
2. Stein, BC, Levin, RI. Natriuretic peptides: physiology, therapeutic potential, and risk stratification in ischemic heart disease. Am Heart J 1998; 135: 914923.
3. Berger, R, Huelsman, M, Strecker, K, et al. B-type natriuretic peptide predicts sudden death in patients with chronic heart failure. Circulation 2002; 105: 23922397.
4. Maisel, AS, Krishnaswamy, P, Nowak, RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002; 347: 161167.
5. de Lemos, JA, McGuire, DK, Drazner, MH. B-type natriuretic peptide in cardiovascular disease. Lancet 2003; 362: 316322.
6. Kunii, Y, Kamada, M, Ohtsuki, S, et al. Plasma brain natriuretic peptide and the evaluation of volume overload in infants and children with congenital heart disease. Acta Med Okayama 2003; 57: 191197.
7. Oyamada, J, Toyono, M, Shimada, S, et al. Noninvasive estimation of left ventricular end-diastolic pressure using tissue Doppler imaging combined with pulsed-wave Doppler echocardiography in patients with ventricular septal defects: a comparison with the plasma levels of the B-type natriuretic peptide. Echocardiography 2008; 25: 270277.
8. Ozhan, H, Albayrak, S, Uzun, H, Ordu, S, Kaya, A, Yazici, M. Correlation of plasma B-type natriuretic peptide with shunt severity in patients with atrial or ventricular septal defect. Pediatr Cardiol 2007; 28: 272275.
9. Paul, MA, Backer, CL, Binns, HJ, et al. B-type natriuretic peptide and heart failure in patients with ventricular septal defect: a pilot study. Pediatr Cardiol 2009; 30: 10941097.
10. Kavga, M, Varlamis, G, Giannopoulos, A, et al. Correlation of plasma B-type natriuretic peptide with shunt volume in children with congenital heart disease involving left-to-right shunt. Hellenic J Cardiol 2013; 54: 192198.
11. Schoen, SP, Zimmermann, T, Kittner, T, et al. NT-proBNP correlates with right heart haemodynamic parameters and volumes in patients with atrial septal defects. Eur J Heart Fail 2007; 9: 660666.
12. Suda, K, Matsumura, M, Matsumoto, M. Clinical implication of plasma natriuretic peptides in children with ventricular septal defect. Pediatr Int 2003; 45: 249254.
13. Jan, SL, Fu, YC, Hwang, B, Lin, SJ. B-type natriuretic peptide in children with atrial or ventricular septal defect: a cardiac catheterization study. Biomarkers 2012; 17: 166171.
14. Sanders, SP, Yeager, S, Williams, RG. Measurement of systemic and pulmonary blood flow and Qp/Qs ratio using Doppler and two dimensional echocardiography. Am J Cardiol 1983; 51: 952956.
15. Boehrer, JD, Lange, RA, Willard, JE, Grayburn, PA, Hillis, LD. Advantages and limitations of methods to detect, localize, and quantitate intracardiac left-to-right shunting. Am Heart J 1992; 124: 448455.
16. Lainchbury, JG, Campbell, E, Frampton, CM, Yandle, TG, Nicholls, MG, Richards, AM. Brain natriuretic peptide and N-terminal brain natriuretic peptide in the diagnosis of heart failure in patients with acute shortness of breath. J Am Coll Cardiol 2003; 42: 728735.
17. Seino, Y, Ogawa, A, Yamashita, T, et al. Application of NT-proBNP and BNP measurements in cardiac care: a more discerning marker for the detection and evaluation of heart failure. Eur J Heart Fail 2004; 6: 295300.
18. Holmstrom, H, Hall, C, Thaulow, E. Plasma levels of natriuretic peptides and hemodynamic assessment of patent ductus arteriosus in preterm infants. Acta Paediatr 2001; 90: 184191.
19. Leuchte, HH, Holzapfel, M, Baumgartner, RA, et al. Clinical significance of brain natriuretic peptide in primary pulmonary hypertension. J Am Coll Cardiol 2004; 43: 764770.
20. Mir, TS, Marohn, S, Läer, S, et al. Plasma concentrations of N-terminal pro-brain natriuretic peptide in control children from the neonatal to adolescent period and in children with congestive heart failure. Pediatrics 2002; 110: e76.
21. Cantinotti, M, Law, Y, Vittorini, S, et al. The potential and limitations of plasma BNP measurement in the diagnosis, prognosis, and management of children with heart failure due to congenital cardiac disease: an update. Heart Fail Rev 2014; 19: 727742.

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