NT-proBNP as Marker of Ventricular Dilatation and Pulmonary Regurgitation After Surgical Correction of Tetralogy of Fallot: A MRI Validation Study
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The goal of this study is to evaluate whether NT-proBNP plasma levels may help as a screening biomarker for monitoring right ventricular dilatation, pulmonary regurgitation and the onset of heart failure in patients with repaired Tetralogy of Fallot. Our single-centre observational prospective study involved 43 patients (15.1 years, SD = 8) with corrected Tetralogy of Fallot. Data collection included: clinical parameters (electrocardiogram, chest X-ray, NYHA scale, time since last surgery), biochemistry (NT-proBNP levels) and MRI values (ventricular volumetry, pulmonary flow assessment). Mean time since last surgery was 13.5 years (SD = 7.8). There was a statistically significant correlation between the NT-proBNP levels (187.4 pg/ml, SD = 154.9) and right ventricular dilatation for both the right ventricular end-diastolic volume (124.9 ml/m2, SD = 31.2) (Pearson = 0.19, p < 0.01) and end-systolic volume (56.1 ml/m2, SD = 18.8) (Pearson = 0.21, p < 0.01) and also with the pulmonary regurgitation fraction (36.5%, SD = 16, Pearson = 0.12, p < 0.01). No significant correlation was found between NT-proBNP and right ventricular ejection fraction (54.6%, SD = 10.6, Pearson = −0.07), left ventricular ejection fraction (59.9%, SD = 7.1, Pearson = −0.18) or any clinical parameters. The receiver operating curve analysis evidenced that a NT-proBNP cut-off value above 133.2 pg/ml predicted the presence of dilated right ventricular end-diastolic and end-systolic volumes over centile 95 (sensitivity 82 and 83% and specificity 93 and 79%, respectively). In conclusion, in patients with surgically corrected Tetralogy of Fallot, NT-proBNP levels correlate with right ventricular dilatation and the degree of pulmonary regurgitation. Ambulatory determination of NT-proBNP might be an easy, readily available and cost-effective alternative for MRI follow-up evaluation of these patients.
KeywordsNT-proBNP Tetralogy of Fallot Congenital heart disease Magnetic resonance imaging
The authors acknowledge the invaluable work and collaboration of the paediatric cardiology team including Dr. Santos, Dr. Gavilan, Dr. Grueso, Dr. Moruno, Dr. Garcia-Angleu, Dr. Coserria and the Magnetic Resonance Unit team including Mr. Alfonso Soto, Dr. Serrano, Dr. Navarro, Dr. Fernandez-Cruz.
This research has been financed by Institute of Health Carlos III—FIS research Grant Number PI14/00180 from the Spanish Ministry of Science and Innovation.
Compliance with Ethical Standards
Conflict of interest
All the authors had full access to the data. They take responsibility for the data presented and their discussed interpretation. None of the authors have any conflicts of interest to declare.
The authors assert that all procedures contributing to this work comply with the Helsinki Declaration of 1975, as revised in 2008, and the local research ethics committee approved this prospective study (Ethics Number 2012PI/159). Informed consent was obtained from patients and legal guardians, as appropriate.
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