Right ventricular function in grown-up patients after correction of congenital right heart disease.

Abstract

AIMS:

We investigated whether a correlation exists between biomarkers of the neurohumoral system and clinical markers in grown-up patients with congenital heart disease (GUCH) and right ventricular function.

METHODS AND RESULTS:

Prospective, cross-sectional, multicenter study of 104 GUCH patients (median) 16 years (range 6-43 years) after corrective surgery with RV pressure and/or volume overload and 54 healthy controls. Clinical, functional, and laboratory parameters were assessed. Natriuretic peptide levels were significantly increased in GUCH patients (NTproBNP 101 vs. 25 pg/ml, p < 0.001), but we observed no differences in norepinephrine, aldosterone, angiotensin II and Endothelin-1 levels. NTproBNP correlated significantly with clinical markers such as NYHA classification, prolonged QRS duration and reduced exercise capacity (VO(2) peak) (all p < 0.001), as well as self-reported quality of life (p < 0.001). MRI and echocardiography derived RV volumes were elevated and ejection fraction reduced in the patients (both p < 0.001). Tissue Doppler parameter showed significantly restricted ventricular longitudinal systolic function (longitudinal tricuspid valve movement, 1.7 vs. 2.3 cm, p < 0.001), suggesting stiffness and reduced RV compliance.

CONCLUSION:

In conclusion, grown-up patients with congenital right heart disease NTproBNP correlates well with various clinical markers of RV failure, such as prolongation of QRS duration, exercise capacity, echocardiography and MRI parameters, and quality of life.

• Authors: Julia Lemmer, Grit Heise, Axel Rentzsch, Petra Boettler, Titus Kuehne, Karl Otto Dubowy, Brigitte Peters, Bjoern Lemmer, Alfred Hager, Brigitte Stiller, German Competence Network for Congenital Heart Defects
• Journal: Clinical research in cardiology : official journal of the German Cardiac Society (Clin Res Cardiol) Vol. 100 Issue 4 Pg. 289-96 (Apr 2011) ISSN: 1861-0692 [Electronic] Germany
• PMID: 20981430 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Peptide Fragments
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain

Topics

• Adolescent
• Adult
• Biomarkers (metabolism)
• Case-Control Studies
• Cross-Sectional Studies
• Echocardiography
• Exercise Test
• Female
• Heart Defects, Congenital (physiopathology, surgery)
• Humans
• Magnetic Resonance Imaging
• Male
• Natriuretic Peptide, Brain (blood)
• Peptide Fragments (blood)
• Postoperative Period
• Prospective Studies
• Quality of Life
• Severity of Illness Index
• Ventricular Function, Right (physiology)
• Young Adult