Serum levels of natriuretic peptides decrease during treatment protocol for univentricular heart (UVH)

  • Dr Anneli Eerola, Department of Pediatrics, University Hospital of Tampere, Finland
  • Dr Eero Jokinen, Hospital for Children and Adolescents, University of Helsinki, Finland
  • Dr Jaana Pihkala, Hospital for Children and Adolescents, University of Helsinki, Finland

    • Purpose. Prospective evaluation of serum levels of N-terminal proatriopeptide (ANPN) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in children treated for UVH.
    Methods. Samples were analyzed in 20 children before first operation, before bidirectional Glenn shunt, at the age of one year, and before total cavopulmonary connection (TCPC). Additionally, we measured peptide levels in 21 children before and 11 after TCPC.
    Results. Between first and second operation, peptide levels decreased (Table). By TCPC, further reduction had taken place. Throughout follow-up, levels were higher than in controls. There was no difference between patients with right and left ventricular morphology. In cross-sectional study, before TCPC, median ANPN concentration measured 0.37 (range 0.18-1.00) nmol/l (P=0.001, compared with controls) and NT-proBNP 156 (range 13-955) ng/l (P<0.001). After TCPC, median ANPN concentration measured 0.39 (range 0.09-0.98) nmol/l (P=0.037) and NT-proBNP 184 (range 76-1406) ng/l (P<0.001).
    Conclusion. Natriuretic peptide levels decrease but remain higher than in controls throughout treatment protocol for UVH. They reflect reduction of volume overload of the single ventricle and can be used for hemodynamic monitoring.

    Table Levels of natriuretic peptides in children during treatment for univentricular heart.

    • * P<0.001; †P<0.01; ‡P<0.05 compared with controls
    • § P<0.001; ║P<0.01; ∞P<0.05 compared with baseline
    • # P<0.01 compared with preGlenn

    Baseline preGlenn 1 year preTCPC controls < 6mos controls >6 mos
    n 20 19 12 11 12 64
    age (years) 0.0(0.0-0.1) 0.3 (0.1-0.4) 1.0(0.7-1.1) 2.1 (1.7-3.5) 0.1(0.0-0.4) 6.8 (0.6-15.6)
    ANPN (nmol/l) 16.80 (0.73-40.20)* 1.80 (0.69-6.10)†§ 0.76 (0.34-10.10)*║ 0.31 (0.26-0.48)‡║# 0.88 (0.51-3.70) 0.28 (0.10-0.61)
    NT-proBNP (ng/l) 24503 (924-35001)* 3020 (119-1751)*║ 311 (225-26393)*∞ 196 (79-718) *║# 281 (122-3224) 57 (14-157)