Serum N-terminal atrial natriuretic peptide in adult patients late after surgical repair of atrial septal defect

• Published in: European journal of heart failure Vol. 2; no. 2; pp. 161 - 165
• Main Authors: Iivainen, Tiina E., Groundstroem, Kaj W.E., Lahtela, Jorma T., Talvensaari, Taisto J., Pasternack, Amos, Uusitalo, Arto
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.06.2000; Elsevier
• Subjects: Adult; Aged; Atrial Natriuretic Factor - blood; Atrial septal defect; Cardiac Surgical Procedures; Congenital heart defect; Female; Haemodynamics; Heart; Heart Septal Defects, Atrial - blood; Heart Septal Defects, Atrial - surgery; Hemodynamics; Humans; Male; Middle Aged; Natriuretic peptide; Postoperative Period; Regression Analysis; Surgery; Heart; Atrial septal defect; Haemodynamics; Congenital heart defect; Surgery; Natriuretic peptide
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1016/S1388-9842(00)00076-3

Background: The purpose of surgical closure of atrial septal defect (ASD) is to relieve the cardiovascular system from a haemodynamic burden. Excessive amounts of atrial peptides are released in congestive heart failure, valvular diseases and congenital heart diseases. Aims: To examine whether patients after surgical repair of ASD have higher concentrations of N-terminal atrial natriuretic peptide (ANP-N) than age-, sex- and body mass index (BMI)-matched control subjects. Methods: Medical history, physical examination, standard 12-lead electrocardiogram, and ANP-N concentrations were obtained in 65 adult patients operated for ASD at the age of 21 ± 13 years (mean ± standard deviation), 21 ± 6 years after surgical closure of ASD. Sixty-seven healthy subjects matched for age, sex and BMI served as controls. Results: In the patients serum ANP-N was higher than in the control subjects 0.41 ± 0.32 nmol/l, median 0.31 nmol/l, interquartile range (IQR) 0.21-0.49 nmol/l vs. 0.24 ± 0.12 nmol/l, median 0.23 nmol/l, IQR 0.17-0.29 nmol/l, (P = 0.0003). Patients with concomitant diseases had higher ANP-N concentrations (0.51 ± 0.39 nmol/l, median 0.34, IQR 0.26-0.73 nmol/l) than ASD patients without any history or signs of disease (0.28 ± 0.16 nmol/l, median 0.27, IQR 0.17-0.40 nmol/l, P = 0.01). The 'healthy' ASD patients had higher hormone concentrations than age-, sex- and BMI-matched control subjects (0.28 ± 0.16 median 0.27 nmol/l, IQR 0.17-0.40 nmol/l and 0.21 ± 0.07 nmol/l, median 0.20 nmol/l, IQR 0.15-0.27 nmol/l, P = 0.01). Multiple stepwise linear regression analysis showed that age at operation was strongly associated with the post-operative ANP-N concentration (r 2 = 0.25, P = 0.0002). Conclusion: ASD patients have higher ANP-N concentrations late after surgical repair. Hormone levels correlate with age at operation. Our finding supports the clinical praxis of operating on these patients in their childhood and adolescence.