NT-proBNP level and left ventricle diameters before and after transcatheter closure of PDA and VSD

Main Article Content

Devy Kusmira
Ria Nova
Achirul Bakri

Abstract

Background Amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels before and after transcatheter closure may correlate with changes in left ventricular internal diameter end diastole (LVIDd) and end systole (LVIDs). Patent ductus arteriosus (PDA) and ventricular septal defect (VSD) are structural abnormalities which effects cardiac hypertrophy. Cardiac muscle stretching decreases after closure, followed by reduced left ventricle diameters and decreased NT-proBNP levels.


Objective To analyze for possible correlations between NT-proBNP levels and left ventricle diameters before and after transcatheter closure.


Methods Subjects were PDA and VSD patients who underwent transcatheter closure in the Pediatrics Department of dr. Moh Hoesin Hospital, Palembang, South Sumatera, from May 2016 to March 2017. Measurement of NT-proBNP levels and echocardiography were performed before closure, as well as one and three months after closure.


Results There were 34 subjects (15 girls) with median age of 91.5 months. Median NT-proBNP levels were significantly reduced after closure: before closure 111.7pg/mL, one month after closure 62pg/mL, and three months after closure 39 pg/mL (P<0.05). Median LVIDd and LVIDs were also significantly reduced after closure [LVIDd: 39.5mm before, 34.5mm one mo after, and 32.5mm 3 mo after (P<0.05); LVIDs: 23.9mm before, 20.5mm 1 mo after, and 20.0mm 3 mo after (P<0.05)]. At one month after closure, there was a moderate positive correlation between NT-proBNP levels and LVIDd (r=0.432; P=0.011), but no correlation with LVIDs (r=0.287; P=0.100). At three months after closure, there was a significant moderate positive correlation between changes of NT-proBNP levels and changes of LVIDd (r=0.459; P=0.006), as well as LVIDs (r=0.563; P=0.001).


Conclusion In pediatric PDA and VSD patients, NT-proBNP levels have a significant positive correlation with diastolic and systolic left ventricle diameters at three months after closure. Decreased NT-proBNP levels may be considered as a marker of closure effectiveness.

Article Details

How to Cite
1.
Kusmira D, Nova R, Bakri A. NT-proBNP level and left ventricle diameters before and after transcatheter closure of PDA and VSD. PI [Internet]. 4Oct.2018 [cited 22Nov.2018];58(5):213-0. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/1758
Section
Articles

References

1. Nir A, Lindinger A, Rauh M, Bar-Oz B, Laer S, Schwachtgen L, et al. NT-pro-B-type natriuretic peptide in infants and children: reference values based on combined data from four studies. Pediatr Cardiol. 2009;30:3–8.
2. de Bold AJ, Ma KK, Zhang Y, de Bold ML, Bensimon M, Khoshbaten A. The physiological and pathophysiological modulation of the endocrine function of the heart. Can J Physiol Pharmacol. 2001;79:705-14.
3. Krupicka J, Janota T, Kasalova Z, Hradec J. Natriuretic peptides – physiology, pathophysiology and clinical use in heart failure. Physiol Res. 2009;58:171-7.
4. Lindmark K, Boman K. Natriuretic peptides. In: Henein MY, editor. Heart failure in clinical practice. London: Springer-Verlag; 2010. p. 309-18.
5. Myung KP. Left to right shunt lesions. In: Pediatric cardiology for practitioners. Philadelphia: Elsevier Saunder; 2014. p. 155-83.
6. Madiyono B, Rahayuningsih SE, Sukardi R. Penanganan penyakit jantung pada bayi dan anak. Jakarta: UKK Kardiologi IDAI; 2005. p.3-13.
7. Djer MM. Penangganan penyakit jantung bawaan tanpa operasi (kardiologi intervensi). Jakarta: Sagung Seto; 2014. p.57-112.
8. Elwan SA, Belal TH, Elaty REA, Salem MA. Diagnostic value of N-terminal pro-brain natriuretic peptide level in pediatric patients with atrial or ventricular septal defect. Med J Cairo Univ. 2015;83:279-83.
9. Mair J, Friedl W, Thomas S, Puschendorf B. Natriuretic peptides in assessment of left-ventricular dysfunction. Scand J Clin Lab Invest.1999;230:132-42.
10. Elsharawy S, Hassan B, Morsy S, Khalifa N. Diagnostic value of N-terminal pro-brain natriuretic peptide levels in pediatric patients with ventricular septal defect. Egypt Heart J. 2012;64:241–6.
11. Eerola A, Jokinen E, Boldt T, Pihkala J. The influence of percutaneous closure of patent ductus arteriosus on left ventricular size and function: a prospective study using two- and three-dimensional echocardiography and measurements of serum natriuretic peptides. J Am Coll Cardiol. 2006;47:1060-6.
12. Fu YC, Bass J, Amin Z, Radtke W, Cheatham JP, Hellenbrand WE, et al. Transcatheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous VSD occluder: results of the U.S. phase I trial. J Am Coll Cardiol. 2006;47:319–25.
13. Mahrani Y, Nova R, Saleh MI and Rahadiyanto KY. Correlation of heart failure severity and N-terminal pro-brain natriuretic peptide level in children. Paediatr Indones. 2016;56: 315-9.
14. Hijazi ZM, Hakim F, Haweleh AA, Madani A, Tarawna W, Hiari A, et al. Catheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous VSD occluder: initial clinical experience. Catheter Cardiovasc Interv. 2002;56:508-15.
15. Djer MM, Saputro DD, Putra ST, Idris NS. Transcatheter closure of patent ductus arteriosus: 11 years
of clinical experience in Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Pediatr Cardiol. 2015;36:1070–4.
16. Al-Hamash SM, Wahab HA, Khalid ZA, Nasser IV. Transcatheter closure of patent ductus arteriosus using ADO device: retrospective study of 149 patients. Heart Views. 2012;13:1-6.
17. Masura J, Gao W, Gavora P, Sun K, Zhou AQ, Jiang S, et al. Percutaneous closure of perimembranous ventricular septal defects with the eccentric Amplatzer device: multicenter follow-up study. Pediatr Cardiol. 2005;26:216-9.
18. Arora R, Trehan V, Kumar A, Kaira GS, Nigam M. Transcatheter closure of congenital ventricular septal defects: experience with various devices. J Interven Cardiol. 2003;16:83–91.
19. Butera G, Carminati M, Chessa M, Piazza L, Micheletti A, Negura DG, et al. Transcatheter closure of perimembranous ventricular septal defects: early and long-term results. J Am Coll Cardiol. 2007;50:1189–95.
20. Butera G, Carminati M, Chessa M, Piazza L, Abella R, Negura DG, et al. Percutaneous closure of ventricular septal defects in children aged < 12: early and mid-term results. Eur Heart J. 2006;27:2889–95.
21. Wang JK, Wu MH, Lin MT, Chiu SN, Chen CA, Chiu HH. Transcatheter closure of moderate-to-large patent ductus arteriosus in infants using Amplatzer duct occluder. Circ J. 2010;74:361-4.
22. Carminati M, Butera G, Chessa M, Drago M, Negura D, Piazza L. Transcatheter closure of congenital ventricular septal defect with Amplatzer septal occluders. Am J Cardiol. 2005;96:52L–8L.
23. Chaudhari M, Chessa M, Stumper O, De Giovanni JV. Transcatheter coil closure of muscular ventricular septal defects. J Interven Cardiol. 2001;14:165–8.
24. Suda K, Matsumura M, Matsumoto M. Clinical implication of plasma natriuretic peptides in children with ventricular septal defect. Pediatr Int. 2003:45:249–54.
25. Yoshimura M, Yasue H, Okumura K, Ogawa H, Jougasaki M, Kuroase M, et al. Different secretion patterns of atrial natriuretic peptide and brain natriuretic peptide in patients with congestive heart failure. Circulation. 1993;87:464–9.
26. Eerola A, Jokinen E, Boldt T, Mattila IP, Pihkala JI. Serum levels of natriuretic peptides in children before and after treatment for an atrial septal defect, a patent ductus arteriosus, and a coarctation of the aorta—a prospective study. Int J Pediatr. 2010;2010:674575.