Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-25T02:34:49.495Z Has data issue: false hasContentIssue false
  • English
  • Français

Utility of biomarkers in adult Fontan patients with decompensated heart failure

Published online by Cambridge University Press:  02 June 2020

Vidang P. Nguyen Open the ORCID record for Vidang P. Nguyen [Opens in a new window] ,
Song Li ,
Stephen J. Dolgner ,
Zachary L. Steinberg  and
Jonathan Buber
Vidang P. Nguyen*
Affiliation:
Department of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
Song Li
Affiliation:
Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
Stephen J. Dolgner
Affiliation:
Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, WA, USA Department of Pediatrics, Seattle Childrens Hospital, Seattle, WA, USA
Zachary L. Steinberg
Affiliation:
Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
Jonathan Buber
Affiliation:
Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
*
Author for correspondence: Vidang Nguyen, Department of Cardiology, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Third Floor Cardiology, Room A3308, Los Angeles, CA, USA. Tel: +1 206 330 1762; Fax: +1 424 315 2880. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

The incidence of heart failure is increasing within the Fontan population. The use of serological markers, including B-type natriuretic peptide, has been limited in this patient population.

Methods:

This was a single-centre retrospective study of Fontan patients in acute decompensated heart failure. Fontan patients underwent a 1:2 match with non-Fontan patients for each heart failure hospitalisation for comparative analysis. A univariate logistic regression model was used to assess associations between laboratory and echocardiographic markers and a prolonged length of stay of 7 days or greater.

Results:

B-type natriuretic peptide levels were significantly lower in Fontan patients admitted for heart failure than that in non-Fontan patients [390.9 (±378.7) pg/ml versus 1245.6 (±1160.7) pg/ml, respectively, p < 0.0001] and were higher in Fontan patients with systemic ventricular systolic or diastolic dysfunction than that in Fontan patients with normal systemic ventricular function [833.6 (±1547.2) pg/ml versus 138.6 (±134.0) pg/ml, p = 0.017]. The change from the last known outpatient value was smaller in Fontan patients in comparison with non-Fontan patients [65.7 (±185.7) pg/ml versus 1638.0 (±1444.7) pg/ml, respectively, p < 0.0001]. Low haemoglobin and high blood urea nitrogen levels were associated with a prolonged length of stay.

Conclusion:

B-type natriuretic peptide levels do not accurately reflect decompensated heart failure in Fontan patients when compared to non-Fontan heart failure patients and should, therefore, be used with caution in this patient population.

Keywords

B-type natriuretic peptidebiomarkercongestive heart failureFontan
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 7 , July 2020 , pp. 955 - 961
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Gewillig, M, Brown, SC.The Fontan circulation after 45 years: update in physiology. Heart (British Cardiac Society) 2016; 102: 1081–1086.Google ScholarPubMed
Karamlou, T, Diggs, BS, Person, T, Ungerleider, RM, Welke, KF.National practice patterns for management of adult congenital heart disease: operation by pediatric heart surgeons decreases in-hospital death. Circulation 2008; 118: 2345–2352.CrossRefGoogle ScholarPubMed
Hebson, C, Book, W, Elder, RW, et al.Frontiers in Fontan failure: a summary of conference proceedings. Congenit Heart Dis 2017; 12: 6–16.10.1111/chd.12407CrossRefGoogle ScholarPubMed
Buber, J, Valente, AM.Predicting survival in adults with congenital heart disease: what are the odds? Heart (British Cardiac Society) 2018; 104: 1643–1644.Google ScholarPubMed
Gewillig, M, Brown, SC, Eyskens, B, et al.The Fontan circulation: who controls cardiac output? Interact Cardiovasc Thorac Surg 2010; 10: 428–433.10.1510/icvts.2009.218594CrossRefGoogle ScholarPubMed
Gewillig, M, Goldberg, DJ.Failure of the fontan circulation. Heart Fail Clin 2014; 10: 105–116.10.1016/j.hfc.2013.09.010CrossRefGoogle ScholarPubMed
Januzzi, JL, Troughton, R.Are serial BNP measurements useful in heart failure management? Serial natriuretic peptide measurements are useful in heart failure management. Circulation 2013; 127: 500–507; discussion 508.CrossRefGoogle ScholarPubMed
Eindhoven, JA, van den Bosch, AE, Ruys, TP, et al.N-terminal pro-B-type natriuretic peptide and its relationship with cardiac function in adults with congenital heart disease. J Am Coll Cardiol 2013; 62: 1203–1212.CrossRefGoogle ScholarPubMed
Burchill, LJ, Redington, AN, Silversides, CK, et al.Renin-angiotensin-aldosterone system genotype and serum BNP in a contemporary cohort of adults late after Fontan palliation. Int J Cardiol 2015; 197: 209–215.CrossRefGoogle Scholar
Heck, PB, Müller, J, Weber, R, Hager, A.Value of N-terminal pro brain natriuretic peptide levels in different types of Fontan circulation. Eur J Heart Fail 2013; 15: 644–649.CrossRefGoogle ScholarPubMed
Assenza, GE, Graham, DA, Landzberg, MJ, et al.MELD-XI score and cardiac mortality or transplantation in patients after Fontan surgery. Heart (British Cardiac Society) 2013; 99: 491–496.Google ScholarPubMed
Nagueh, SF, Smiseth, OA, Appleton, CP, et al.Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur heart J Cardiovasc Imaging 2016; 17: 1321–1360.CrossRefGoogle ScholarPubMed
Lang, RM, Bierig, M, Devereux, RB, et al.Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiog 2005; 18: 1440–1463.CrossRefGoogle ScholarPubMed
Book, WM, Gerardin, J, Saraf, A, Marie Valente, A, Rodriguez, F, 3rd. Clinical phenotypes of Fontan failure: implications for management. Congenit Heart Dis 2016; 11: 296–308.CrossRefGoogle ScholarPubMed
Atz, AM, Zak, V, Breitbart, RE, et al.Factors associated with serum brain natriuretic peptide levels after the Fontan procedure. Congenit Heart Dis 2011; 6: 313–321.CrossRefGoogle ScholarPubMed
Burchill, LJ, Gao, L, Kovacs, AH, et al.Hospitalization trends and health resource use for adult congenital heart disease-related heart failure. J Am Heart Assoc 2018; 7: e008775.CrossRefGoogle ScholarPubMed
Silverberg, DS, Wexler, D, Blum, M, et al.The use of subcutaneous erythropoietin and intravenous iron for the treatment of the anemia of severe, resistant congestive heart failure improves cardiac and renal function and functional cardiac class, and markedly reduces hospitalizations. J Am Coll Cardiol 2000; 35: 1737–1744.CrossRefGoogle ScholarPubMed
Cedars, A, Benjamin, L, Burns, SV, Novak, E, Amin, A.Clinical predictors of length of stay in adults with congenital heart disease. Heart (British Cardiac Society) 2017; 103: 1258–1263.Google ScholarPubMed
Opotowsky, AR, Baraona, FR, Mc Causland, FR, et al.Estimated glomerular filtration rate and urine biomarkers in patients with single-ventricle Fontan circulation. Heart (British Cardiac Society) 2017; 103: 434–442.Google ScholarPubMed
Saraf, A, De Staercke, C, Everitt, I, et al. Biomarker profile in stable Fontan patients. Int J Cardiol 2020; 305: 56–62.10.1016/j.ijcard.2020.01.012CrossRefGoogle Scholar
Opotowsky, AR, Baraona, F, Owumi, J, et al.Galectin-3 Is elevated and associated with adverse outcomes in patients with single-ventricle Fontan circulation. J Am Heart Assoc 2016; 5.CrossRefGoogle ScholarPubMed
Sugimoto, M, Saiki, H, Tamai, A, et al.Ventricular fibrogenesis activity assessed by serum levels of procollagen type III N-terminal amino peptide during the staged Fontan procedure. J Thorac Cardiovasc Surg 2016; 151: 1518–1526.CrossRefGoogle ScholarPubMed
Shirali, AS, Lluri, G, Guihard, PJ, et al.Angiopoietin-2 predicts morbidity in adults with Fontan physiology. Sci Rep 2019; 9: 18328.CrossRefGoogle ScholarPubMed
Miranda, C, Taqatqa, A, Chapa-Rodriguez, A, Holton, JP, Awad, SM.The use of fecal calprotectin levels in the Fontan population. Pediatr Cardiol 2018; 39: 591–594.CrossRefGoogle ScholarPubMed
Supplementary material: File

Nguyen et al. supplementary material

Table S1

Download Nguyen et al. supplementary material(File)
File 110.4 KB