Aminoterminal brain-type natriuretic peptide levels correlate with heart failure in patients with bidirectional Glenn anastomosis and with morbidity after the Fontan operation

Lechner, Evelyn; Schreier-Lechner, Elisabeth M.; Hofer, Anna; Gitter, Roland; Mair, Rudolf; Biebl, Ariane; Tulzer, Gerald

doi:10.1016/j.jtcvs.2009.03.005

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 3 , Pages 560-564, September 2009

Aminoterminal brain-type natriuretic peptide levels correlate with heart failure in patients with bidirectional Glenn anastomosis and with morbidity after the Fontan operation

Evelyn Lechner, MD
- Pediatric Cardiology, Children's and Maternity Hospital Linz, Linz, Austria
- Address for reprints: Evelyn Lechner, MD, Children's and Maternity Hospital Linz, Krankenhausstrasse 26-30, 4020 Linz, Austria.
Elisabeth M. Schreier-Lechner, MD
- Clinical Laboratory, Children's and Maternity Hospital Linz, Linz, Austria
Anna Hofer, MD
- Anesthesiology and Intensive Care, General Hospital Linz, Linz, Austria
Roland Gitter, MD
- Pediatric Cardiology, Children's and Maternity Hospital Linz, Linz, Austria
Rudolf Mair, MD
- Congenital Heart Surgery, General Hospital Linz, Linz, Austria
Ariane Biebl, MD
- Department of General Pediatrics, Children's and Maternity Hospital Linz, Linz, Austria
Gerald Tulzer, MD, PhD
- Pediatric Cardiology, Children's and Maternity Hospital Linz, Linz, Austria

Received 12 December 2008; received in revised form 14 February 2009; accepted 8 March 2009. published online 11 May 2009.

Objective

The aims of this study were to generate normal values of aminoterminal pro–brain natriuretic peptide in children with a bidirectional Glenn anastomosis without congestive heart failure and to test the hypothesis that plasma levels of aminoterminal pro–brain natriuretic peptide correlate with the clinical severity of congestive heart failure and morbidity after the Fontan operation.

Methods

Aminoterminal pro–brain natriuretic peptide plasma levels of 78 patients after the bidirectional Glenn operation with a median age of 3.2 years and a median follow-up time of 3 years were measured by using an automated enzyme immunoassay. The severity of heart failure was quantified by using the New York University Pediatric Heart Failure Index.

Results

The 97.5th percentile of aminoterminal pro–brain natriuretic peptide level in patients without congestive heart failure was 339 pg/mL. Aminoterminal pro–brain natriuretic peptide levels strongly correlated with the New York University Pediatric Heart Failure Index score (P < .001). In patients with congestive heart failure (31/78), the aminoterminal pro–brain natriuretic peptide levels were significantly higher (median, 670 pg/mL) than in patients without congestive heart failure (median, 171 pg/mL). In 41 patients who underwent the Fontan operation, the time to removal of chest tubes and the length of hospital stay positively correlated with the preoperative value of aminoterminal pro–brain natriuretic peptide.

Conclusions

In children with a bidirectional Glenn anastomosis without signs of heart failure, aminoterminal pro–brain natriuretic peptide levels were within the normal range and correlated with the severity of congestive heart failure. Further studies are needed to determine whether aminoterminal pro–brain natriuretic peptide levels can aide clinicians in the early detection of congestive heart failure in this patient group.

Abbreviations and Acronyms: BDG, bidirectional Glenn, BNP, brain natriuretic peptide, BTS, Blalock–Taussig shunt, CHF, congestive heart failure, LV, left ventricular, NT–pro-BNP, aminoterminal pro–brain natriuretic peptide, NYUPHFI, New York University Pediatric Heart Failure Index, RV, right ventricular