Objectives To evaluate the correlation between right ventricular systolic function, volume, and plasma brain natriuretic peptide (BNP) levels in adults with congenital heart disease (CHD).
Background Right ventricular function is an important though often undervalued prognostic factor in patients with heart failure. Plasma BNP levels are moderately elevated in patients with right ventricular pressure and/or volume overload. We sought to define the correlation between plasma BNP level and right ventricular volume and systolic function in a cohort of adults with CHD.
Methods The transthoracic echocardiograms (TTE), magnetic resonance cine-gradient echo (MRI), and serum BNP levels of adults with CHD were reviewed. Correlation coefficients were sought between BNP and right ventricular systolic pressure (RVSP), right and left ventricular ejection fractions (RVEF/LVEF), right ventricular end-systolic volume (RVESV), and end-diastolic volume (RVEDV). MRI was utilized to determine RVESV and RVEDV via application of the Simpson's rule by manual planimetry of the endocardial and epicardial borders of both ventricles in the short axis. The RVEF was calculated as the stroke volume divided by the RVEDV. A similar method was utilized to quantify LVEF. Right and left ventricular muscle mass (RVMM/LVMM) were quantified by measuring the volume of the myocardium multiplied by the specific gravity of myocardium. TTE was also used to estimate RVEF and LVEF as well as estimate RVSP from tricuspid valve regurgitant velocity using the modified Bernoulli equation.
Results Nine adults with various types of CHD (4 tetralogy of Fallot, 2 bicuspid aortic valve, 2 double outlet right ventricle, 1 double outlet left ventricle) were included in this analysis. Serum BNP levels correlated significantly with MRI-derived RVESV (r = .88, p = .01) and RVEDV (r = .82, p = .01). A significant inverse correlation existed between BNP levels and MRI-derived RVEF (r = -.74, p = .01) and echo-estimated RVEF (r = -.86, p = .01). Echo- and MRI-derived LVEF did not correlate significantly with BNP levels. All patients with BNP > 100 had RVEF ≤ 50%, RVESV ≥ 55 mL. RVSP and RVMM were not correlated with BNP levels.
Conclusions In adults with CHD, MRI-derived RVESV and RVEDV significantly correlated with plasma BNP level. RVEF but not LVEF was inversely correlated with BNP level. Right ventricular systolic and diastolic volume and systolic function are closely associated with plasma BNP in adults with CHD.
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