Document Detail


Factors associated with serum brain natriuretic peptide levels after the Fontan procedure.
MedLine Citation:
PMID:  21435188     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Although a useful marker of heart failure in adults, the utility of brain natriuretic peptide concentration (BNP) for children after the Fontan procedure is not well studied.
DESIGN: BNP was measured in 510 patients who were 6-18 years old in the Pediatric Heart Network Fontan cross-sectional study at a median of 8.2 years after Fontan. Patients underwent echocardiography, exercise testing, magnetic resonance imaging (MRI) and functional health status questionnaires. Associations of BNP with baseline patient characteristics, medical history and cross-sectional assessment were examined with multivariable linear regression analyses.
RESULTS: The distribution of BNP was highly skewed, median 13.0 pg/mL (interquartile range: 7.1, 25.9), and was normalized with logarithmic transformation (logBNP). Among medical history variables, logBNP was greater in females (P= .02) and older patients (P < .001). Presence of pre-Fontan systolic ventricular dysfunction, greater number of post-Fontan complications, and thrombosis after Fontan were independently associated with higher logBNP (R(2) = 0.16). Age-adjusted logBNP was significantly related to Fontan connection type (lower with extracardiac conduits, higher with atriopulmonary connection; P < .001). Lower physical functioning health status (R(2) = 0.05), lower chronotropic index during exercise (R(2) = 0.17), indices of diastolic dysfunction measured by echocardiography (R(2) = 0.15), and higher total ventricular mass on MRI (R(2) = 0.33) were related to higher logBNP.
CONCLUSIONS: Despite a markedly abnormal circulation, BNP was variable but within a normal range in the majority of Fontan patients in this large outpatient cohort. Higher BNP was associated with several markers of suboptimal outcome, although associations were weak. The routine use of BNP as an outpatient surveillance tool in asymptomatic Fontan patients is not warranted.
Authors:
Andrew M Atz; Victor Zak; Roger E Breitbart; Steven D Colan; Sara K Pasquali; Daphne T Hsu; Minmin Lu; Lynn Mahony; Stephen M Paridon; Michael D Puchalski; Tal Geva; Brian W McCrindle;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural     Date:  2011-03-25
Journal Detail:
Title:  Congenital heart disease     Volume:  6     ISSN:  1747-0803     ISO Abbreviation:  Congenit Heart Dis     Publication Date:    2011 Jul-Aug
Date Detail:
Created Date:  2011-07-22     Completed Date:  2011-11-28     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  101256510     Medline TA:  Congenit Heart Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  313-21     Citation Subset:  IM    
Copyright Information:
© 2011 Copyright the Authors. Congenital Heart Disease © 2011 Wiley Periodicals, Inc.
Affiliation:
Medical University of South Carolina, Charleston, SC 29425, USA. atzam@musc.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Biological Markers / blood
Child
Cross-Sectional Studies
Female
Fontan Procedure* / adverse effects
Health Status
Heart Defects, Congenital / blood,  physiopathology,  surgery*
Humans
Linear Models
Male
Natriuretic Peptide, Brain / blood*
Ontario
Prospective Studies
Time Factors
Treatment Outcome
United States
Grant Support
ID/Acronym/Agency:
HL068269/HL/NHLBI NIH HHS; HL068270/HL/NHLBI NIH HHS; HL068279/HL/NHLBI NIH HHS; HL068281/HL/NHLBI NIH HHS; HL068285/HL/NHLBI NIH HHS; HL068288/HL/NHLBI NIH HHS; HL068290/HL/NHLBI NIH HHS; HL068292/HL/NHLBI NIH HHS; U01 HL068281-10/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Biological Markers; 114471-18-0/Natriuretic Peptide, Brain
Investigator
Investigator/Affiliation:
Gail Pearson / ; Mario Stylianou / ; Judith Massicot-Fisher / ; Marsha Mathis / ; Lynn Sleeper / ; Steven Colan / ; Paul Mitchell / ; Dianne Gallagher / ; Patti Nash / ; Gloria Klein / ; Minmin Lu / ; Lynn Mahony / ; Jane Newburger / ; Stephen Roth / ; Roger Breitbart / ; Jonathan Rhodes / ; Jodi Elder / ; Ellen McGrath / ; Welton M Gersony / ; Daphne T Hsu / ; Seema Mital / ; Beth Printz / ; Ashwin Prakash / ; Darlene Servedio / ; Victoria Vetter / ; Bernard J Clark / ; Mark Fogel / ; Steven Paridon / ; Jack Rychik / ; Jamie Koh / ; Page A W Anderson / ; Rene Herlong / ; Lynne Hurwitz / ; Jennifer S Li / ; Ann Marie Nawrocki / ; J Philip Saul / ; Andrew M Atz / ; Andrew D Blaufox / ; Girish Shirali / ; Jon Lucas / ; Amy Blevins / ; LuAnn Minich / ; Richard Williams / ; Linda Lambert / ; Michael Puchalski / ; Brian McCrindle / ; Timothy Bradley / ; Kevin Roman / ; Jennifer Russell / ; Shi Joon Yoo / ; Elizabeth Radojewski / ; Tal Geva / ; Andrew J Powell / ; Steven Colan / ; Marcy Schwartz / ; Renee Margossian / ; Michael Artman / ; Dana Connolly / ; Timothy Feltes / ; Julie Johnson / ; Jeffrey Krischer / ; G Paul Matherne / ; John Kugler / ; Kathryn Davis / ; David J Driscoll / ; Mark Galantowicz / ; Sally A Hunsberger / ; Thomas J Knight / ; Catherine L Webb / ; Lawrence Wissow /
Comments/Corrections

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