Brain natriuretic peptide as a biomarker of systemic right ventricular function in patients with transposition of great arteries after atrial switch operation

Background: Assessment of systemic right ventricular ( RV) function is inherently difficult. In adults, plasma brain natriuretic peptide (BNP) level has been shown to reflect systemic ventricular dysfunction. We sought to test the hypothesis that plasma BNP is a biomarker of systemic RV function in patients after atrial switch operation. Methods: We determined the RV function in 44 patients, 35 after Senning and 9 after Mustard operation, aged 19.7 +/- 4.0 years, by tissue Doppler echocardiography and determination of myocardial performance index (MPI). The results were compared to the left ventricular function of 14 age-matched controls. Their plasma BNP levels were correlated with indices of systemic ventricular function. Results: Compared with controls, the patients had greater MPI (p < 0.001), lower systemic ventricular free wall-annular early diastolic (p < 0.001), late diastolic (p < 0.001), and systolic velocities (p=0.001), lower septal-annular early diastolic (p < 0.001), late diastolic (p < 0.001), and systolic velocities (p < 0.001), and higher BNP levels (p=0.03). Plasma BNP levels correlated positively with MPI (r=0.43, p=0.001) and negatively with the free wall- and septal-annular myocardial velocities (r=-0.32 to -0.47, p < 0.05). The area under the receiver operating characteristic curve for BNP to detect ventricular dysfunction (MPI > 0.45) in patients was 0.67 (p=0.04). A BNP level of 36 pg/ml had a sensitivity of 55%, specificity of 86%, positive predictive value 80%, negative predictive value of 64%, and an accuracy of 70% for detecting systemic ventricular dysfunction. Conclusions: Plasma BNP has modest accuracy in the detection of systemic RV dysfunction in patients after atrial switch operation. (c) 2007 Elsevier Ireland Ltd. All rights reserved.