Usefulness of Serum Brain Natriuretic Peptide to Predict Adverse Events in Patients With the Eisenmenger Syndrome

Study Questions:

What is the prognostic value of brain natriuretic peptide (BNP) in outpatients with Eisenmenger syndrome?

Methods:

A retrospective review was performed at a single tertiary referral center. The primary endpoint was death or heart failure admission. Patients who had single consultations or did not have BNP levels obtained were excluded from analysis.

Results:

A total of 53 patients were studied, of whom 15 met the primary endpoint (death in seven, heart failure hospitalization in eight patients). The mean and median baseline BNP in patients meeting the primary endpoint were 322 ± 346 and 179 pg/ml, as compared with 100 ± 157 and 41 pg/ml in those not meeting the primary endpoint (p = 0.0029). The relative risk for baseline BNP level >140 pg/ml was 4.62 (95% confidence interval, 1.19-2.85; p = 0.006). Patients who met the primary endpoint showed increase in their BNP levels by 42.5 pg/ml per year, as compared with 7.2 pg/ml per year (p = 0.007) in patients who did not meet the primary endpoint.

Conclusions:

Elevated BNP levels are predictive of mortality or heart failure admission in patients with Eisenmenger physiology. A BNP level >140 pg/ml may be a useful tool in identifying patients at increased risk for adverse outcomes.

Perspective:

This study supports other recent studies suggesting elevated BNP levels to be predictive of poor outcomes in patients with Eisenmenger physiology (Diller GP, et al., Heart 2012;98:736-42). While the previous study suggested 100 pg/ml as a cutoff for adverse outcomes, this study suggests a cutoff of 140 pg/ml. Nevertheless, BNP appears to have a role in prognosticating outcomes in patients with Eisenmenger physiology. The patient population in this study was likely consistent with that of most tertiary referral centers, with a large portion of patients with complex anatomy, particularly those with single-ventricle lesions.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Congenital Heart Disease, CHD and Pediatrics and Quality Improvement, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Tertiary Care Centers, Prognosis, Risk, Eisenmenger Complex, Biological Markers, Heart Defects, Congenital, Outpatients, Heart Failure, Confidence Intervals, Heart Ventricles, Natriuretic Peptide, Brain


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