Prognostic Value of Plasma B-Type Natriuretic Peptide in the Long-Term Follow-up of Patients With Transposition of the Great Arteries With Morphologic Right Systemic Ventricle After Atrial Switch Operation

• Published in: Circulation Journal Vol. 79; no. 12; pp. 2677 - 2681
• Main Authors: Haberger, Stefanie, Hauser, Michael, Braun, Siegmund L., Schuster, Tibor, Ewert, Peter, Nagdyman, Nicole, Hess, John, Kaemmerer, Harald
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2015
• Subjects: Adolescent; Adult; Atrial switch operation; B-type natriuretic peptide; Cardiac event; Cardiac Surgical Procedures; Congenital heart disease; Disease-Free Survival; Female; Follow-Up Studies; Heart Ventricles; Humans; Male; Natriuretic Peptide, Brain - blood; Survival Rate; Transposition of Great Vessels - blood; Transposition of Great Vessels - mortality; Transposition of Great Vessels - surgery; Transposition of the great arteries
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-15-0348

Background:B-type natriuretic peptide (BNP) is an established marker for heart failure assessment, but the prognostic quality of BNP after atrial switch operation (ASO) has not yet been elucidated.Methods and Results:In 89 patients (median age, 24 years; range, 15–35 years) after ASO, BNP was measured. During a 48-months follow-up we focused on critical cardiac events, defined as decompensation, sudden cardiac death or need for heart transplantation. BNP was considerably lower in 81 patients in functional class (FC) I/II (median, 35 pg/ml; range, 3–586 pg/ml) than in 6 patients in FC III/IV (median, 246 pg/ml; range, 14–1,150 pg/ml, P≤0.073). BNP was significantly higher after Mustard than after Senning procedure (P≤0.030). There was no significant difference in BNP between simple or complex transposition of the great arteries (TGA) (P≤0.44). Eleven subjects (13%, 95% CI: 7–22%) had a critical cardiac event within 48 months. On ROC analysis BNP had a high predictive value regarding discrimination of patients with and without critical events (area under the ROC curve, 0.90; 95% CI: 0.76 to >0.99, P<0.001). The cut-off was 85 pg/ml (sensitivity, 88%; specificity, 85%). Additionally, estimated event-free-survival was longer after Senning than after Mustard procedure (P≤0.017). There was no significant difference in outcome between patients with simple or complex TGA with regard to occurrence of critical events.Conclusions:BNP is a sensitive and specific prognostic marker for critical cardiac events after ASO. (Circ J 2015; 79: 2677–2681)