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Assessment of biventricular functional reserve and NT-proBNP levels in patients with RV volume overload after repair of tetralogy of Fallot at young age.
Int J Cardiol. 2009 Apr 17; 133(3):364-70.IJ

Abstract

PURPOSE

To assess biventricular functional reserve (FR), NT-proBNP levels and exercise performance, in relation to right ventricular volume in patients with pulmonary regurgitation (PR) after repair of tetralogy of Fallot (TOF) at young age.

METHODS

In 53 TOF patients (maximum age at repair 2.0 years, interval since repair 15 (5) years) without residual lesions except PR, biventricular FR (derived from magnetic resonance imaging with dobutamine stress), NT-proBNP levels, maximal workload, and peak oxygen uptake were assessed.

RESULTS

Mean right ventricular end-diastolic volume was 140(38) ml/m(2). Median pulmonary regurgitant fraction was 37% (range 0-57%). Biventricular systolic stress response was normal: mean (SD) ESV decreased (DeltaRVESV -17(8) ml/m(2), DeltaLVESV -11(5)), SV increased (DeltaRVSV +12(9) ml/m(2), DeltaLVSV +9(6)), FR was positive in all (RV-FR +11(5)%, LV-FR +13(6)). No serious adverse effects to dobutamine were encountered. NT-proBNP was increased in 2 patients. Median level was 10 pmol/L (range 2-42). NT-proBNP correlated with PR-percentage but not with right ventricular size. High-risk levels of NT-proBNP indicated a smaller RV-FR and a smaller decrease of biventricular ESV. Mean (SEM) VO2(max) was 96(3)%, mean Workload(max) 89(2)% of predicted.

CONCLUSION

At mid to long term follow-up overall NT-proBNP levels are normal and biventricular functional reserve and exercise tolerance are well preserved in TOF repaired at young age, irrespective of RV volume. This questions the validity of isolated PR or RV volume criteria for pulmonary valve replacement in this group. Low-dose dobutamine stress testing is well tolerated and may be a useful additional tool for clinical decision making.

Authors+Show Affiliations

Department of Pediatrics, Erasmus MC, Rotterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18495276

Citation

van den Berg, Jochem, et al. "Assessment of Biventricular Functional Reserve and NT-proBNP Levels in Patients With RV Volume Overload After Repair of Tetralogy of Fallot at Young Age." International Journal of Cardiology, vol. 133, no. 3, 2009, pp. 364-70.
van den Berg J, Strengers JL, Wielopolski PA, et al. Assessment of biventricular functional reserve and NT-proBNP levels in patients with RV volume overload after repair of tetralogy of Fallot at young age. Int J Cardiol. 2009;133(3):364-70.
van den Berg, J., Strengers, J. L., Wielopolski, P. A., Hop, W. C., Meijboom, F. J., de Rijke, Y. B., Boomsma, F., Bogers, A. J., Pattynama, P. M., & Helbing, W. A. (2009). Assessment of biventricular functional reserve and NT-proBNP levels in patients with RV volume overload after repair of tetralogy of Fallot at young age. International Journal of Cardiology, 133(3), 364-70. https://doi.org/10.1016/j.ijcard.2008.01.011
van den Berg J, et al. Assessment of Biventricular Functional Reserve and NT-proBNP Levels in Patients With RV Volume Overload After Repair of Tetralogy of Fallot at Young Age. Int J Cardiol. 2009 Apr 17;133(3):364-70. PubMed PMID: 18495276.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of biventricular functional reserve and NT-proBNP levels in patients with RV volume overload after repair of tetralogy of Fallot at young age. AU - van den Berg,Jochem, AU - Strengers,Jan L M, AU - Wielopolski,Piotr A, AU - Hop,Wim C, AU - Meijboom,Folkert J, AU - de Rijke,Yolanda B, AU - Boomsma,Frans, AU - Bogers,Ad J J C, AU - Pattynama,Peter M T, AU - Helbing,Willem A, Y1 - 2008/05/20/ PY - 2007/07/18/received PY - 2007/12/30/revised PY - 2008/01/11/accepted PY - 2008/5/23/pubmed PY - 2010/1/12/medline PY - 2008/5/23/entrez SP - 364 EP - 70 JF - International journal of cardiology JO - Int J Cardiol VL - 133 IS - 3 N2 - PURPOSE: To assess biventricular functional reserve (FR), NT-proBNP levels and exercise performance, in relation to right ventricular volume in patients with pulmonary regurgitation (PR) after repair of tetralogy of Fallot (TOF) at young age. METHODS: In 53 TOF patients (maximum age at repair 2.0 years, interval since repair 15 (5) years) without residual lesions except PR, biventricular FR (derived from magnetic resonance imaging with dobutamine stress), NT-proBNP levels, maximal workload, and peak oxygen uptake were assessed. RESULTS: Mean right ventricular end-diastolic volume was 140(38) ml/m(2). Median pulmonary regurgitant fraction was 37% (range 0-57%). Biventricular systolic stress response was normal: mean (SD) ESV decreased (DeltaRVESV -17(8) ml/m(2), DeltaLVESV -11(5)), SV increased (DeltaRVSV +12(9) ml/m(2), DeltaLVSV +9(6)), FR was positive in all (RV-FR +11(5)%, LV-FR +13(6)). No serious adverse effects to dobutamine were encountered. NT-proBNP was increased in 2 patients. Median level was 10 pmol/L (range 2-42). NT-proBNP correlated with PR-percentage but not with right ventricular size. High-risk levels of NT-proBNP indicated a smaller RV-FR and a smaller decrease of biventricular ESV. Mean (SEM) VO2(max) was 96(3)%, mean Workload(max) 89(2)% of predicted. CONCLUSION: At mid to long term follow-up overall NT-proBNP levels are normal and biventricular functional reserve and exercise tolerance are well preserved in TOF repaired at young age, irrespective of RV volume. This questions the validity of isolated PR or RV volume criteria for pulmonary valve replacement in this group. Low-dose dobutamine stress testing is well tolerated and may be a useful additional tool for clinical decision making. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/18495276/Assessment_of_biventricular_functional_reserve_and_NT_proBNP_levels_in_patients_with_RV_volume_overload_after_repair_of_tetralogy_of_Fallot_at_young_age_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(08)00302-1 DB - PRIME DP - Unbound Medicine ER -