Prognostic value of NT-proBNP in patients with systemic morphological right ventricles: A single-centre experience

Abstract

In systemic morphological right ventricles after atrial redirection surgery, NT-proBNP is correlated with NYHA-class, ventricular function and subaortic AV-valve regurgitation (TR). The impact of NT-proBNP on adverse clinical outcomes is, however, unknown. MethodsThis prospectively designed, longitudinal, observational study evaluated NT-proBNP in 116 patients (24.9±4.2years old, NYHA class I/II/III=97/18/1, 71 men) relative to all cardiac causes of hospitalisation, heart failure, transplantation and death. ResultsThe mean observation time was 7.3±2.4years. In univariate Cox proportion analysis, the predictors for all causes of hospitalisation (n=41; 35.5%) were NT-proBNP (HR: 5.99; 95%CI: 3.21–11.18), NYHA class (HR: 2.98; 95%CI: 1.62–5.5), ventricular function (HR: 1.96; 95%CI: 1.27–3.02), TR (HR: 2.39; 95%CI: 1.48–3.59), ventricular septal defect repair (HR: 1.29; 95%CI: 1.08–1.53) and a history of supraventricular tachycardia (SVT) (HR: 7.13; 95%CI: 3.74–13.59). In multivariate Cox proportion analysis, NT-proBNP (HR: 3.71; 95%CI: 1.82–7.57), SVT (HR: 4.27; 95%CI: 2.03–8.94) and ventricular septal defect repair (HR: 1.41; 95%CI: 1.15–1.72) remained independently associated with all causes of hospitalisation.For heart failure, transplantation and death, the single predictors were NT-proBNP (HR: 20.67; 95%CI: 4.69–91.78), NYHA class (HR: 6.45; 95%CI: 2.75–15.14), ventricular function (HR: 2.70; 95%CI: 1.48–4.92), TR (HR: 4.11; 95%CI: 1.99–8.47), QRS duration (HR: 2.09; 95%CI: 1.06–4.12) and SVT (HR: 8.00; 95%CI: 2.82–22.69). Multivariate Cox proportion analysis identified NT-proBNP (HR: 6.82; 95%CI: 1.32–35.04) and NYHA class (HR: 6.79; 95%CI: 1.75–26.28). Using ROC curves, the ability of NT-proBNP to detect patients at risk was greater for heart failure, transplantation and death (AUC: 0.944; 95%CI: 0.900–0.988) than for all causes of hospitalisation (AUC: 0.8; 95%CI: 0.713–0.887). ConclusionIn systemic right ventricles, NT-proBNP is a useful risk predictor for all causes of hospitalisation and, in particular, for heart failure, transplantation and death. It therefore might be a useful tool for risk assessment in this patient population.