Interrelationships between plasma N-terminal pro-brain natriuretic peptide ( Nt-proBNP), troponin I ( TnI), and high sensitivity C -Reactive Protein (hs- CRP) in children and adolescent submitted to surgical repair of atrial septal defect ( ASD)

  • Massimo Colaneri, Cardiochirurgia e Cardiologia Pediatrica e Congenita - Ospedali Riuniti - Ancona, Italy
  • Maria Bettuzzi, Cardiochirurgia e Cardiologia Pediatrica e Congenita - Ospedali Riuniti - Ancona, Italy
  • Alessandra Baldinelli, Cardiochirurgia e Cardiologia Pediatrica e Congenita - Ospedali Riuniti - Ancona, Italy
  • Roberto Ricciotti, Cardiochirurgia e Cardiologia Pediatrica e Congenita - Ospedali Riuniti - Ancona, Italy
  • Andrea Quarti, Cardiochirurgia e Cardiologia Pediatrica e Congenita - Ospedali Riuniti - Ancona, Italy
  • Alessandro D' Alfonso, Cardiochirurgia e Cardiologia Pediatrica e Congenita - Ospedali Riuniti - Ancona, Italy
  • Marco Pozzi, Cardiochirurgia e Cardiologia Pediatrica e Congenita - Ospedali Riuniti - Ancona, Italy

    • Background : Nt-proBNP, TnI and hs-CRP are circulating markers of ventricular function, myocardial damage and inflammation.

    Objective: To determine the interrelationships between preoperative and postoperative levels of these markers in pts undergone ASD surgical repair.


    Methods: Markers blood levels were measured before surgery and after 1, 24, 48 , 72, 96, 120 and 144 hours in 45 pts (median age 5.1 years , range 0.5-15.8 years, 24 boys ) submitted to surgical repair of ostium secundum ASD.



    Results:
    Preoperative and post-operative peak values of Nt-proBNP, TnI and hs-CRP are showed
    in table 1.

    Preoperative Nt-proBNP was significantly correlated to postoperative Nt-proBNP ( r= 0.57, p < 0.001) and postoperative TnI ( r= 0.30, p < 0.05 ).
    Postoperative Nt-proBNP was highly correlated to postoperative TnI ( r= 0.63, p < 0.001).
    No significant correlations were observed between preoperative Nt-proBNP and postoperative Nt-proBNP /postoperative TnI versus postoperative hs-CRP



    Conclusions:
    Nt-proBNP is significantly elevated before surgery in pts with ASD.
    Nt-proBNP, TnI and hs-CRP significantly increase after repair of ASD.
    After surgery there is a strong interplay between neurohormonal activation and myocardial damage.
    On the contrary inflammatory activation appears uncorrelated to neurohormonal
    activation and myocardial damage.

    Tab. 1. Preoperative and postoperative peak values of Nt-proBNP, TnI and hs-CRP
    Nt-proBNP (pg/ml) TnI (ng/ml) hs-CRP (mg/dL)
    Median (range) Median (range) Median (range)
    Time
    Preoperative 147° (27-1096) 0.01 (0.01-0.04) 0.3 (0.3-0.5)
    Postoperative peak 3799** (546-21239) 2.71* (1.19-15.63) 9.1** (2.9-18.3)
    ° p <0.05 versus normal values; * p <0.05 and **p < 0.001) versus preoperative values ( Wilcoxon test )