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Published in: Netherlands Heart Journal 11/2016

Open Access 01-11-2016 | Original Article

NT-proBNP and exercise capacity in adult patients with congenital heart disease and a prosthetic valve: a multicentre PROSTAVA study

Authors: R. C. Schoonbeek, P. G. Pieper, Y. J. van Slooten, H. G. Freling, G. T. Sieswerda, A. P. J. van Dijk, M. R. M. Jongbloed, M. C. Post, B. J. Bouma, R. M. F. Berger, T. Ebels, J. P. van Melle

Published in: Netherlands Heart Journal | Issue 11/2016

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Abstract

Objectives

N-terminal B‑type natriuretic peptide (NT-proBNP) is an important biomarker for the detection of heart failure. Adults with congenital heart disease (ACHD) and a prosthetic heart valve are at risk for heart failure. This study aimed to determine the value of NT-proBNP in ACHD patients with a prosthetic valve and investigate its relationship with cardiac function and exercise capacity.

Methods

In this multi-centre cross-sectional observational study, data regarding medical history, echocardiography, exercise testing (VO2peak) and laboratory blood evaluation (including NT-proBNP) were collected in ACHD patients with a single prosthetic valve (either homografts, heterografts or mechanical valves).

Results

A total of 306 ACHD patients with pulmonary valve replacement (PVR, n = 139), aortic valve replacement (n = 141), mitral valve replacement (n = 21) or tricuspid valve replacement (n = 5) were investigated. The majority of patients (77 %) were in NYHA class I or II. Elevated NT-proBNP levels (cut-off ≥125 pg/ml) were found in 50 % of the patients, with the highest levels in patients with mitral valve replacements. In this study population, NT-proBNP levels were associated with gender (p = 0.029) and VO2max (p < 0.001). In PVR patients, NT-proBNP levels were associated with lower VO2peak, also after adjustment for age, gender and age at valve replacement in a multivariate model (p = 0.015).

Conclusions

In patients with ACHD and a prosthetic valve, elevated NT-proBNP levels are frequently observed despite preserved NYHA class. In PVR patients, a higher NT-proBNP level was associated with a lower VO2peak. These results may be of importance in the ongoing discussion about the timing of valve replacement in patients with CHD.
Literature
1.
go back to reference van Veldhuisen DJ, Linssen GC, Jaarsma T, et al. B‑type natriuretic peptide and prognosis in heart failure patients with preserved and reduced ejection fraction. J Am Coll Cardiol. 2013;61:1498–506.CrossRefPubMed van Veldhuisen DJ, Linssen GC, Jaarsma T, et al. B‑type natriuretic peptide and prognosis in heart failure patients with preserved and reduced ejection fraction. J Am Coll Cardiol. 2013;61:1498–506.CrossRefPubMed
2.
go back to reference Scrutinio D, Ammirati E, Guida P, et al. Clinical utility of N‑terminal pro-B-type natriuretic peptide for risk stratification of patients with acute decompensated heart failure. Derivation and validation of the ADHF/NT-proBNP risk score. Int J Cardiol. 2013;168:2120–6.CrossRefPubMed Scrutinio D, Ammirati E, Guida P, et al. Clinical utility of N‑terminal pro-B-type natriuretic peptide for risk stratification of patients with acute decompensated heart failure. Derivation and validation of the ADHF/NT-proBNP risk score. Int J Cardiol. 2013;168:2120–6.CrossRefPubMed
3.
go back to reference Oremus M, Don-Wauchope A, McKelvie R, et al. BNP and NT-proBNP as prognostic markers in persons with chronic stable heart failure. Heart Fail Rev. 2014;19:471–505.CrossRefPubMed Oremus M, Don-Wauchope A, McKelvie R, et al. BNP and NT-proBNP as prognostic markers in persons with chronic stable heart failure. Heart Fail Rev. 2014;19:471–505.CrossRefPubMed
4.
go back to reference Melina G, Angeloni E, Benedetto U, et al. Relationship between prosthesis patient mismatch and pro-brain natriuretic peptides after aortic valve replacement. J Heart Valve Dis. 2010;19:171–6.PubMed Melina G, Angeloni E, Benedetto U, et al. Relationship between prosthesis patient mismatch and pro-brain natriuretic peptides after aortic valve replacement. J Heart Valve Dis. 2010;19:171–6.PubMed
5.
go back to reference Eindhoven JA, van den Bosch AE, Ruys TP, et al. N‑terminal pro-B-type natriuretic peptide and its relationship with cardiac function in adults with congenital heart disease. J Am Coll Cardiol. 2013;62:1203–12.CrossRefPubMed Eindhoven JA, van den Bosch AE, Ruys TP, et al. N‑terminal pro-B-type natriuretic peptide and its relationship with cardiac function in adults with congenital heart disease. J Am Coll Cardiol. 2013;62:1203–12.CrossRefPubMed
6.
go back to reference van der Linde D, Konings EE, Slager MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol. 2011;58:2241–7.CrossRefPubMed van der Linde D, Konings EE, Slager MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol. 2011;58:2241–7.CrossRefPubMed
7.
go back to reference Diller GP, Kempny A, Alonso-Gonzalez R, et al. Survival prospects and circumstances of death in contemporary adult congenital heart disease patients under follow-up at a large tertiary centre. Circulation. 2015;132:2118–25.CrossRefPubMed Diller GP, Kempny A, Alonso-Gonzalez R, et al. Survival prospects and circumstances of death in contemporary adult congenital heart disease patients under follow-up at a large tertiary centre. Circulation. 2015;132:2118–25.CrossRefPubMed
8.
go back to reference Pibarot P, Dumesnil JG, Cartier PC, Metras J, Lemieux MD. Patient-prosthesis mismatch can be predicted at the time of operation. Ann Thorac Surg. 2001;71(5 Suppl):265–8.CrossRef Pibarot P, Dumesnil JG, Cartier PC, Metras J, Lemieux MD. Patient-prosthesis mismatch can be predicted at the time of operation. Ann Thorac Surg. 2001;71(5 Suppl):265–8.CrossRef
9.
go back to reference O’Byrne ML, Glatz AC, Mercer-Rosa L, Gillespie MJ, Dori Y, Goldmuntz E, et al. Trends in pulmonary valve replacement in children and adults with tetralogy of fallot. Am J Cardiol. 2015;115:118–24.CrossRefPubMed O’Byrne ML, Glatz AC, Mercer-Rosa L, Gillespie MJ, Dori Y, Goldmuntz E, et al. Trends in pulmonary valve replacement in children and adults with tetralogy of fallot. Am J Cardiol. 2015;115:118–24.CrossRefPubMed
10.
go back to reference van der Velde ET, Vriend JW, Mannens MM, Uiterwaal CS, Brand R, Mulder BJ. CONCOR, an initiative towards a national registry and DNA-bank of patients with congenital heart disease in the Netherlands: rationale, design, and first results. Eur J Epidemiol. 2005;20:549–57.CrossRefPubMed van der Velde ET, Vriend JW, Mannens MM, Uiterwaal CS, Brand R, Mulder BJ. CONCOR, an initiative towards a national registry and DNA-bank of patients with congenital heart disease in the Netherlands: rationale, design, and first results. Eur J Epidemiol. 2005;20:549–57.CrossRefPubMed
11.
go back to reference Freling HG, van Slooten YJ, van Melle JP, et al. Prosthetic valves in adult patients with congenital heart disease: rationale and design of the Dutch PROSTAVA study. Neth Heart J. 2012;20:419–24.CrossRefPubMedPubMedCentral Freling HG, van Slooten YJ, van Melle JP, et al. Prosthetic valves in adult patients with congenital heart disease: rationale and design of the Dutch PROSTAVA study. Neth Heart J. 2012;20:419–24.CrossRefPubMedPubMedCentral
12.
go back to reference McMurray JJ, Adamopoulos S, Anker SD, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2012;14:803–69.CrossRefPubMed McMurray JJ, Adamopoulos S, Anker SD, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2012;14:803–69.CrossRefPubMed
13.
go back to reference Zoghbi WA, Chambers JB, Dumesnil JG, et al. Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report from the American Society of Echocardiography’s Guidelines and standards committee and the task force on prosthetic valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2009;22:975–1014, quiz 1082–1084.CrossRefPubMed Zoghbi WA, Chambers JB, Dumesnil JG, et al. Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report from the American Society of Echocardiography’s Guidelines and standards committee and the task force on prosthetic valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2009;22:975–1014, quiz 1082–1084.CrossRefPubMed
14.
go back to reference Capps SB, Elkins RC, Fronk DM. Body surface area as a predictor of aortic and pulmonary valve diameter. J Thorac Cardiovasc Surg. 2000;119:975–82.CrossRefPubMed Capps SB, Elkins RC, Fronk DM. Body surface area as a predictor of aortic and pulmonary valve diameter. J Thorac Cardiovasc Surg. 2000;119:975–82.CrossRefPubMed
15.
go back to reference Ascoop CAPL, Van Zeijl LGPM, Pool J, Simoons ML. Cardiac exercise testing. Indications, staff, equipment, conduct and procedures. Neth J Cardiol. 1989;2:63–72. Ascoop CAPL, Van Zeijl LGPM, Pool J, Simoons ML. Cardiac exercise testing. Indications, staff, equipment, conduct and procedures. Neth J Cardiol. 1989;2:63–72.
16.
go back to reference Guazzi M, Adams V, Conraads V, et al. EACPR/AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation. 2012;126:2261–74.CrossRefPubMedPubMedCentral Guazzi M, Adams V, Conraads V, et al. EACPR/AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation. 2012;126:2261–74.CrossRefPubMedPubMedCentral
17.
go back to reference Bleiziffer S, Eichinger WB, Hettich I, et al. Impact of patient-prosthesis mismatch on exercise capacity in patients after bioprosthetic aortic valve replacement. Heart. 2008;94:637–41.CrossRefPubMed Bleiziffer S, Eichinger WB, Hettich I, et al. Impact of patient-prosthesis mismatch on exercise capacity in patients after bioprosthetic aortic valve replacement. Heart. 2008;94:637–41.CrossRefPubMed
18.
go back to reference Mishra RK, Li Y, Ricardo AC, et al. Association of N‑terminal pro-B-type natriuretic peptide with left ventricular structure and function in chronic kidney disease (from the Chronic Renal Insufficiency Cohort [CRIC]). Am J Cardiol. 2013;111:432–8.CrossRefPubMed Mishra RK, Li Y, Ricardo AC, et al. Association of N‑terminal pro-B-type natriuretic peptide with left ventricular structure and function in chronic kidney disease (from the Chronic Renal Insufficiency Cohort [CRIC]). Am J Cardiol. 2013;111:432–8.CrossRefPubMed
19.
go back to reference Meijers WC, Hoekstra T, Jaarsma T, van Veldhuisen DJ, de Boer RA. Patients with heart failure with preserved ejection fraction and low levels of natriuretic peptides. Neth Heart J. 2016;24:287–95.CrossRefPubMedPubMedCentral Meijers WC, Hoekstra T, Jaarsma T, van Veldhuisen DJ, de Boer RA. Patients with heart failure with preserved ejection fraction and low levels of natriuretic peptides. Neth Heart J. 2016;24:287–95.CrossRefPubMedPubMedCentral
20.
go back to reference Eindhoven JA, Menting ME, van den Bosch AE, et al. Associations between N‑terminal pro-B-type natriuretic peptide and cardiac function in adults with corrected tetralogy of Fallot. Int J Cardiol. 2014;174:550–6.CrossRefPubMed Eindhoven JA, Menting ME, van den Bosch AE, et al. Associations between N‑terminal pro-B-type natriuretic peptide and cardiac function in adults with corrected tetralogy of Fallot. Int J Cardiol. 2014;174:550–6.CrossRefPubMed
21.
go back to reference Luchner A, Behrens G, Stritzke J, et al. Long-term pattern of brain natriuretic peptide and N‑terminal pro brain natriuretic peptide and its determinants in the general population: contribution of age, gender, and cardiac and extra-cardiac factors. Eur J Heart Fail. 2013;15:859–67.CrossRefPubMed Luchner A, Behrens G, Stritzke J, et al. Long-term pattern of brain natriuretic peptide and N‑terminal pro brain natriuretic peptide and its determinants in the general population: contribution of age, gender, and cardiac and extra-cardiac factors. Eur J Heart Fail. 2013;15:859–67.CrossRefPubMed
22.
go back to reference Luijnenburg SE, Peters RE, van der Geest RJ, et al. Abnormal right atrial and right ventricular diastolic function relate to impaired clinical condition in patients operated for tetralogy of Fallot. Int J Cardiol. 2013;167:833–9.CrossRefPubMed Luijnenburg SE, Peters RE, van der Geest RJ, et al. Abnormal right atrial and right ventricular diastolic function relate to impaired clinical condition in patients operated for tetralogy of Fallot. Int J Cardiol. 2013;167:833–9.CrossRefPubMed
23.
go back to reference van Slooten YJ, van Melle JP, Freling HG, et al. Aortic valve prosthesis patient mismatch and exercise capacity in adult patients with congenital heart disease. Heart. 2016;102:107–13.CrossRefPubMed van Slooten YJ, van Melle JP, Freling HG, et al. Aortic valve prosthesis patient mismatch and exercise capacity in adult patients with congenital heart disease. Heart. 2016;102:107–13.CrossRefPubMed
24.
go back to reference Norozi K, Buchhorn R, Kaiser C, et al. Plasma N‑terminal pro-brain natriuretic peptide as a marker of right ventricular dysfunction in patients with tetralogy of Fallot after surgical repair. Chest. 2005;128:2563–70.CrossRefPubMed Norozi K, Buchhorn R, Kaiser C, et al. Plasma N‑terminal pro-brain natriuretic peptide as a marker of right ventricular dysfunction in patients with tetralogy of Fallot after surgical repair. Chest. 2005;128:2563–70.CrossRefPubMed
25.
go back to reference Bove T, Vandekerckhove K, Devos D, et al. Functional analysis of the anatomical right ventricular components: should assessment of right ventricular function after repair of tetralogy of Fallot be refined? Eur J Cardiothorac Surg. 2014;45:e6–12.CrossRefPubMed Bove T, Vandekerckhove K, Devos D, et al. Functional analysis of the anatomical right ventricular components: should assessment of right ventricular function after repair of tetralogy of Fallot be refined? Eur J Cardiothorac Surg. 2014;45:e6–12.CrossRefPubMed
Metadata
Title
NT-proBNP and exercise capacity in adult patients with congenital heart disease and a prosthetic valve: a multicentre PROSTAVA study
Authors
R. C. Schoonbeek
P. G. Pieper
Y. J. van Slooten
H. G. Freling
G. T. Sieswerda
A. P. J. van Dijk
M. R. M. Jongbloed
M. C. Post
B. J. Bouma
R. M. F. Berger
T. Ebels
J. P. van Melle
Publication date
01-11-2016
Publisher
Bohn Stafleu van Loghum
Published in
Netherlands Heart Journal / Issue 11/2016
Print ISSN: 1568-5888
Electronic ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-016-0896-5

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