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Brain natriuretic peptide and magnetic resonance imaging in tetralogy with right ventricular dilatation.
Ann Thorac Surg. 2006 Sep; 82(3):983-8.AT

Abstract

BACKGROUND

Cardiac volumetry by magnetic resonance imaging can guide the timing for reoperation in minimally symptomatic or asymptomatic patients with pulmonary insufficiency after corrected tetralogy of Fallot. Pro-brain natriuretic peptide (BNP) is a marker of ventricular dysfunction and wall stress, and levels may complement magnetic resonance imaging in cardiac assessment before and after pulmonary valve replacement.

METHODS

Between May 2004 and October 2005, 23 consecutive patients with corrected tetralogy, severe pulmonary insufficiency, and right ventricular end-diastolic volume index greater than 150 mL/m2 underwent elective pulmonary valve replacement. Plasma proBNP levels and magnetic resonance imaging were obtained before and 6 months after pulmonary valve replacement.

RESULTS

There was no surgical mortality or morbidity. Preoperative right ventricular end-diastolic volume index correlated with pulmonary insufficiency, and inversely so with left ventricular ejection fraction, reflecting interventricular interaction. Preoperatively (r = -0.47) and 6 months postoperatively (r = -0.54), log BNP was inversely correlated with right ventricular ejection fraction. Mean preoperative proBNP levels, right ventricular end-diastolic volume index, and pulmonary insufficiency significantly (p < 0.0001) diminished 6 months after pulmonary valve replacement (231 versus 114 ng/L, 184 versus 109 mL/m2, and 44% versus 2%, respectively).

CONCLUSIONS

Plasma proBNP is elevated in patients with corrected tetralogy, severe pulmonary insufficiency, and right ventricular dilatation, and it significantly diminishes 6 months after pulmonary valve replacement, mirroring magnetic resonance imaging-documented better right ventricular ejection fraction and smaller right ventricular end-diastolic volume index. Pro-brain natriuretic peptide complements magnetic resonance imaging for cardiac assessment in patients requiring pulmonary valve insertion. Future validation of cutoff levels are required to establish proBNP as a useful diagnostic and follow-up tool in patients with chronic pulmonary insufficiency and failing right ventricles.

Authors+Show Affiliations

Division of Congenital Cardiovascular Surgery, University Children's Hospital, University of Zürich, Zürich, Switzerland. ali.dodge-khatami@kispi.unizh.chNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

16928520

Citation

Dodge-Khatami, Ali, et al. "Brain Natriuretic Peptide and Magnetic Resonance Imaging in Tetralogy With Right Ventricular Dilatation." The Annals of Thoracic Surgery, vol. 82, no. 3, 2006, pp. 983-8.
Dodge-Khatami A, Büchel EV, Knirsch W, et al. Brain natriuretic peptide and magnetic resonance imaging in tetralogy with right ventricular dilatation. Ann Thorac Surg. 2006;82(3):983-8.
Dodge-Khatami, A., Büchel, E. V., Knirsch, W., Kadner, A., Rousson, V., Dave, H. H., Bauersfeld, U., & Prêtre, R. (2006). Brain natriuretic peptide and magnetic resonance imaging in tetralogy with right ventricular dilatation. The Annals of Thoracic Surgery, 82(3), 983-8.
Dodge-Khatami A, et al. Brain Natriuretic Peptide and Magnetic Resonance Imaging in Tetralogy With Right Ventricular Dilatation. Ann Thorac Surg. 2006;82(3):983-8. PubMed PMID: 16928520.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Brain natriuretic peptide and magnetic resonance imaging in tetralogy with right ventricular dilatation. AU - Dodge-Khatami,Ali, AU - Büchel,Emanuela Valsangiacomo, AU - Knirsch,Walter, AU - Kadner,Alexander, AU - Rousson,Valentin, AU - Dave,Hitendu H, AU - Bauersfeld,Urs, AU - Prêtre,René, PY - 2006/01/26/received PY - 2006/03/10/revised PY - 2006/03/14/accepted PY - 2006/8/25/pubmed PY - 2006/9/14/medline PY - 2006/8/25/entrez SP - 983 EP - 8 JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. VL - 82 IS - 3 N2 - BACKGROUND: Cardiac volumetry by magnetic resonance imaging can guide the timing for reoperation in minimally symptomatic or asymptomatic patients with pulmonary insufficiency after corrected tetralogy of Fallot. Pro-brain natriuretic peptide (BNP) is a marker of ventricular dysfunction and wall stress, and levels may complement magnetic resonance imaging in cardiac assessment before and after pulmonary valve replacement. METHODS: Between May 2004 and October 2005, 23 consecutive patients with corrected tetralogy, severe pulmonary insufficiency, and right ventricular end-diastolic volume index greater than 150 mL/m2 underwent elective pulmonary valve replacement. Plasma proBNP levels and magnetic resonance imaging were obtained before and 6 months after pulmonary valve replacement. RESULTS: There was no surgical mortality or morbidity. Preoperative right ventricular end-diastolic volume index correlated with pulmonary insufficiency, and inversely so with left ventricular ejection fraction, reflecting interventricular interaction. Preoperatively (r = -0.47) and 6 months postoperatively (r = -0.54), log BNP was inversely correlated with right ventricular ejection fraction. Mean preoperative proBNP levels, right ventricular end-diastolic volume index, and pulmonary insufficiency significantly (p < 0.0001) diminished 6 months after pulmonary valve replacement (231 versus 114 ng/L, 184 versus 109 mL/m2, and 44% versus 2%, respectively). CONCLUSIONS: Plasma proBNP is elevated in patients with corrected tetralogy, severe pulmonary insufficiency, and right ventricular dilatation, and it significantly diminishes 6 months after pulmonary valve replacement, mirroring magnetic resonance imaging-documented better right ventricular ejection fraction and smaller right ventricular end-diastolic volume index. Pro-brain natriuretic peptide complements magnetic resonance imaging for cardiac assessment in patients requiring pulmonary valve insertion. Future validation of cutoff levels are required to establish proBNP as a useful diagnostic and follow-up tool in patients with chronic pulmonary insufficiency and failing right ventricles. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/16928520/Brain_natriuretic_peptide_and_magnetic_resonance_imaging_in_tetralogy_with_right_ventricular_dilatation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(06)00584-4 DB - PRIME DP - Unbound Medicine ER -