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

Iivainen, Tiina; Groundstroem, Kaj; Lahtela, Jorma; Talvensaari, Taisto; Pasternack, Amos; Uusitalo, Arja

doi:10.1016/s1388-9842(00)00076-3

Cited by 24 publications

(16 citation statements)

References 18 publications

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“…Even though the considerable majority of studied patients did not present the signs and symptoms of heart failure, their plasma BNP levels were significantly higher than in the control group. Elevated BNP levels in patients with congenital heart disease (mainly in children) were also observed by other investigators [18,23,24,25,26,27,28]. Bolger et al [18] showed in 56 adult patients with congenital heart disease that increased BNP levels were not directly related to abnormal heart anatomy, but only to NYHA functional class.…”

Section: Discussionsupporting

confidence: 54%

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Evaluation of Exercise Capacity with Cardiopulmonary Exercise Testing and Type B Natriuretic Peptide Concentrations in Adult Patients with Patent Atrial Septal Defect

Trojnarska¹,

Szyszka²,

Gwizdała³

et al. 2006

Cardiology

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Adults with patent atrial septal defect (ASD) usually find their exercise capacity satisfactory, and therefore hesitate to accept proposed surgical treatment of the heart disease. The aim of our study was to evaluate both the exercise capacity, using the cardio-pulmonary stress test, and brain natriuretic peptide (BNP) levels in asymptomatic adults with ASD. Thirty-six patients with patent secundum type ASD (aged mean 44.7 ± 8.2 years) were studied. The control group consisted of 25 healthy subjects at the mean age of 45.6 ± 6.1 years. Echocardiography and CPST were performed and BNP levels measured in all subjects. Oxygen uptake (VO_{2 max}) was lower in ASD patients than in controls (22.1 ± 5.6 vs. 30.0 ± 6.8 ml/kg/min, p = 0.00001); the VE/VO₂ slope was elevated in ASD patients compared with healthy subjects (31.3 ± 6.6 vs. 26.9 ± 3.3, p = 0.001), and exceeded 34 in 5 patients. VO_{2 max} showed a negative correlation with the pulmonary to systemic flow ratio Qp:Qs (r = –0.46, p = 0.004), and a positive correlation was found between the VE/VO₂ slope and Qp:Qs (r = 0.32, p = 0.05). BNP levels were higher in the ASD group than in the controls (60.6 ± 49.9 vs. 32.6 ± 24.5 pg/ml, p = 0.02). BNP correlated positively with RV diameter and Qp:Qs (r = 0.38 and 0.39 respectively, p = 0.03) and negatively with maximum VO₂ (r = –0.5, p = 0.004) and VO₂% (r = –0.32, p = 0.07). Conclusions: Although most adult patients with ASD perceive their exercise capacity as satisfactory, objective assessment reveals that in fact it is significantly decreased. BNP levels are increased comparing to healthy individuals. Decreased exercise capacity and increased BNP levels seem to result from right ventricular volume overload.

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Section: Discussionsupporting

confidence: 54%

“…Few studies have shown increased BNP levels in right ventricular failure [23, 24]. The analyses of BNP levels in patients with congenital heart diseases are also sparse [18,23,24,25,26,27,28]. We are not aware of any reports on serum BNP levels in adults with patent ASD.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Exercise Capacity with Cardiopulmonary Exercise Testing and Type B Natriuretic Peptide Concentrations in Adult Patients with Patent Atrial Septal Defect

Trojnarska¹,

Szyszka²,

Gwizdała³

et al. 2006

Cardiology

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“…However, this study and that of Iivainen et al, 18 demonstrating that N-terminal ANP levels are elevated 2 decades after routine closure of atrial septal defects, suggest that this situation may not endure. Subtle and persistent abnormalities of cardiac or extracardiac structure and function may continue to drive neurohormonal activation, albeit to a lesser extent than in surgically naive disease.…”

Section: Circulation July 2 2002contrasting

confidence: 61%

“…The few published studies in this patient group have considered only the natriuretic peptides in specific anatomic groups. [17][18][19] Activation of the sympathoadrenergic, renin-angiotensin-aldosterone, and endothelin systems has not been described in adults with congenital heart disease. Furthermore, it is not known whether neurohormonal activation in such patients relates to common measures of disease severity such as functional class, exercise capacity, and measures of ventricular function (as in CHF) or whether specific patterns of cardiac anatomy are more important discriminants.…”

mentioning

confidence: 99%

Neurohormonal Activation and the Chronic Heart Failure Syndrome in Adults With Congenital Heart Disease

et al. 2002

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Background — Neurohormonal activation characterizes chronic heart failure, relates to outcome, and is a therapeutic target. It is not known whether a similar pattern of neurohormonal activation exists in adults with congenital heart disease and, if so, whether it relates to common measures of disease severity or whether cardiac anatomy is a better discriminant. Methods and Results — Concentrations of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), endothelin-1 (ET-1), renin, aldosterone, norepinephrine, and epinephrine were determined in 53 adults with congenital heart disease, comprising 4 distinct anatomic subgroups (29 female; 33.5±1.5 years of age; New York Heart Association class 2.0±0.1, mean±SEM) and 15 healthy control subjects (8 female; 32.3±1.3 years of age). Systemic ventricular function was graded by a blinded echocardiographer as normal or mildly, moderately, or severely impaired. Adults with congenital heart disease had elevated levels of ANP (56.6 versus 3.1 pmol/L), BNP (35.8 versus 5.7 pmol/L), ET-1 (2.5 versus 0.7 pmol/L, all P <0.0001), renin (147 versus 16.3 pmol/L), norepinephrine (2.2 versus 1.6 pmol/L, both P <0.01) and aldosterone (546 versus 337 pmol/L, P <0.05). There was a highly significant stepwise increase in ANP, BNP, ET-1, and norepinephrine according to New York Heart Association class and systemic ventricular function, with even asymptomatic patients having evidence of significant neurohormonal activation. In contrast, there was no direct relationship between the 4 anatomic subgroups and any of the neurohormones studied. Conclusions — Neurohormonal activation in adult congenital heart disease bears the hallmarks of chronic heart failure, relating to symptom severity and ventricular dysfunction and not necessarily to anatomic substrate. Neurohormonal antagonism across this large and anatomically diverse population should be considered.

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“…The present results confirm the findings of other studies showing significantly elevated levels of natriuretic peptides in various types of congenital and valvular heart diseases [3][4][5] . Other studies have shown a relationship between concentrations of natriuretic peptides and severity of heart failure [6][7][8][9][10][11][12] .…”

Section: Discussionsupporting

confidence: 92%

Evidence for Natriuretic Peptides a and B as Non-Invasive Markers in Congenital and Valvular Heart Disease

Kotaška¹,

Průša²

2010

BIOMED PAP

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Aim. The aim of this study was to evaluate the diagnostic utility of natriuretic peptides of type A and B as noninvasive markers in the diagnosis and treatment of congenital and valvular heart disease.Methods. Blood samples from 82 patients with various congenital and valvular heart diseases were measured for A and B natriuretic peptide levels and levels compared with those in a reference group of blood donors. Electrochemiluminiscence immunoassay and immunoluminometric essay were used for quantification of natriuretic peptides A and B. Particular reference values in serum or plasma of blood donors were adapted from literature.Results. Natriuretic peptide levels in cardiac patients were significantly higher than reference levels. The levels of both peptides in blood serum or plasma showed positive correlation with age, gender and disease severity.Conclusions. Natriuretic peptides are efficient, non-invasive cardiac markers for facilitating diagnosis, management and treatment of valvular heart disease.

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

Cited by 24 publications

References 18 publications

Evaluation of Exercise Capacity with Cardiopulmonary Exercise Testing and Type B Natriuretic Peptide Concentrations in Adult Patients with Patent Atrial Septal Defect

Evaluation of Exercise Capacity with Cardiopulmonary Exercise Testing and Type B Natriuretic Peptide Concentrations in Adult Patients with Patent Atrial Septal Defect

Neurohormonal Activation and the Chronic Heart Failure Syndrome in Adults With Congenital Heart Disease

Evidence for Natriuretic Peptides a and B as Non-Invasive Markers in Congenital and Valvular Heart Disease

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