Author + information
- Jannet A. Eindhoven, MD,
- Annemien E. van den Bosch, MD, PhD,
- Eric Boersma, PhD and
- Jolien W. Roos-Hesselink, MD, PhD∗ ()
- ↵∗Department of Cardiology, Erasmus Medical Center, P.O. Box 2040, Rotterdam 3000CA, the Netherlands
We thank Dr. Cantinotti and colleagues for their response to our paper (1) describing the clinical usefulness of N-terminal pro–B-type natriuretic peptide (NT-proBNP) in adults with congenital heart disease (CHD) and showing correlations with echocardiographic and exercise parameters.
As Dr. Cantinotti and colleagues state, the finding that the NT-proBNP level was not correlated with the severity of the initial disease was unexpected. NT-proBNP levels in patients with surgically corrected atrial septal defects are known to be slightly elevated (2). However, the remarkably low NT-proBNP levels in patients after undergoing an arterial switch operation are surprising and, together with their normal cardiac function and exercise capacity, all mirror a good clinical condition. These are promising factors for the long-term outcome of these patients. Because this is the first report of NT-proBNP in adults undergoing an arterial switch operation and our study population was relatively small, further research on these patients is clearly warranted.
We agree with Dr. Cantinotti and colleagues that absolute NT-proBNP levels must be interpreted in the context of the individual patient characteristics. Noncardiac factors including age, sex, and renal function are known to influence NT-proBNP levels (3); therefore, patients with renal dysfunction were excluded from our study, and in our statistical analyses, we adjusted for age and sex. Nevertheless, all adults with CHD have a unique medical history, with or without cyanosis and varying from no to multiple surgical interventions, that may have influenced cardiac loading conditions and consequent NT-proBNP release. Future research should focus on the various CHDs in combination with patients' medical history to improve interpretation of individual B-type natriuretic peptide (BNP) results.
The production and excretion of BNP and NT-proBNP is a complex process that is influenced by mechanical, neurohormonal, and immunological factors (4), and novel cardiac biomarkers such as ST2, galectin-3, and GDF-15 (5,6) have been gaining in interest recently. Possibly, in the future, a multimarker approach together with established diagnostic tools could improve decision making in the specialist care of this unique patient population.
- 2014 American College of Cardiology Foundation