NT-proBNP levels and their relationship with systemic ventricular impairment in adult patients with transposition of the great arteries long after Mustard or Senning procedure

2015 ◽  
Vol 53 (8) ◽  
Author(s):  
Karel Kotaska ◽  
Jana Popelova ◽  
Richard Prusa
Keyword(s):  
Nyha Class ◽  
Right Ventricular Ejection Fraction ◽  
Functional Class ◽  
Adult Patients ◽  
Control Group ◽  
Healthy Individuals ◽  
Ventricular Ejection Fraction ◽  
Atrial Switch ◽  
Senning Operation ◽  
The Relationship

AbstractThe aim of the study was to investigate serum NT-proBNP levels in adult patients with transposition of the great arteries (d-TGA) corrected by atrial switch procedures (Mustard or Senning) operation and to assess the relationship with ventricular impairment and NYHA class.Serum NT-proBNP levels were measured in a group of 81 consecutive adult patients (59 males, mean age 27 years and 22 females, mean age 28 years) with transposition of the great arteries (TGA) after surgical correction in childhood, and in a control group of 25 healthy individuals (16 males, mean age 32 years, and 9 females, mean age 29 years). Age-matched correlation of NT-proBNP concentrations in TGA patients after Mustard or Senning correction was performed, but this correlation was considered not significant (p=0.08).Concentrations of NT-proBNP in patients with TGA were significantly elevated compared to the control group of healthy individuals (203 ng/L vs. 41 ng/L, p<0.0001). Patients after the Mustard repair had significantly higher NT-proBNP values than patients after the Senning operation (234 ng/L vs. 148 ng/L, p=0.0023). NT-proBNP correlated negatively with the systemic right ventricular ejection fraction with the greatest significance in patients after Mustard correction (r=–0.32, p<0.0001). The concentration of NT-proBNP was also associated with NYHA functional class (p=0.0035) with the greatest significance in patients with Mustard correction (p=0.028).Elevated levels of NT-proBNP appear to be a useful tool in assessing heart failure in patients with transposition of the great arteries after atrial switch correction.

scholarly journals Biomarker sST2 in Adults with Transposition of the Great Arteries Palliated by Mustard Procedure

2020 ◽  
Vol 3 ◽  
Author(s):  
Haley Ferguson ◽  
Hugo Martinez ◽  
Melanie Pride ◽  
Roger Hurwitz ◽  
Mark Payne
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Mechanical Strain ◽  
Functional Class ◽  
Control Group ◽  
Class Iii ◽  
Healthy Individuals ◽  
Mustard Operation ◽  
Lipid Panel ◽  
Mustard Procedure

Background: Transposition of the great arteries (TGA) is a congenital heart defect (CHD) in which the aorta and pulmonary artery are transposed; it requires urgent surgical intervention. The Mustard procedure was an early surgery allowing survival into adulthood. However, this procedure is associated with long-term adverse effects including arrhythmias and heart failure (HF). A key factor impairing HF management in adults with CHD is lack of biomarkers to predict outcome. Soluble ST2 (sST2) is a protein secreted by myocytes in response to mechanical strain and fibrosis. No studies have focused specifically on sST2 in TGA individuals that underwent a Mustard procedure.  In this study, we hypothesized adults with TGA palliated with a Mustard procedure would have higher levels of sST2 than healthy individuals, and this would correlate with functional class status.      Methods: We screened the Pediatric Cardiology database for D-TGA subjects and Mustard operation. Healthy controls were recruited from clinic and the community. Patients were matched by age to a control group of 21 healthy individuals.  Severity of symptoms was assessed by NYHA functional classification. sST2 levels were obtained using Critical Diagnostics Presage ST2 Assay kit. Additionally, cTnI, BNP, lipid panel, insulin, glucose, and EKG and echocardiography (TGA) were obtained at IUSM clinical laboratories.      Results: We identified 45 patients with D-TGA and Mustard operation. 19 patients were included in analysis: 12 male and 7 female subjects aged 18 to 46, mean of 34.9 years. In the Mustard group, 9 subjects were assigned to NYHA class II, and 9 to class III. The control group was asymptomatic. sST2 levels in the Mustard group were elevated in 53%, while only 29% in the controls. Of the Mustard subjects with elevated sST2, 67% had elevated cTnI, 80% arrhythmias, 70% EKG T-wave abnormalities, and 80% took cardiac medications.  90% of these patients had low HDL, 40% high LDL, and 40% low insulin.      Conclusion: This study demonstrates patients with Mustard operation averaged higher sST2 levels than healthy subjects. Importantly, of the patients with elevated levels, there was a significant association of sST2 with biomarker abnormalities and clinical heart failure signs.  This suggests in patients with D-TGA palliated with Mustard procedure, sST2 may add predictive value to cardiac related morbidity and mortality.  

The Senning operation for complete transposition: mid-term physiologic, electrophysiologic, and functional results

1991 ◽  
Vol 1 (1) ◽  
pp. 80-83 ◽  
Author(s):  
Walter H. Merrill ◽  
James R. Stewart ◽  
John W. Hammon ◽  
James A. Johns ◽  
Harvey W. Bender
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Right Ventricular Ejection Fraction ◽  
Functional Class ◽  
Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Junctional Rhythm ◽  
Complete Transposition ◽  
Senning Operation

SummaryWe report analysis of surgical results in 110 consecutive infants and children who underwent atrial repair of simple complete transposition using the Senning operation between February 1978 and May 1990. Mean age at operation was 5.4 months ± 6.1 (range 1 week to 4 years); 75 were less than 6 months old. There were 72 males and 38 females. Operative mortality rate was 5.5%, with one late death. Average follow-up is 48.1 months with 44 followed greater than 3 years, and 27 greater than 5 years. Postoperative cardiac catheterization was performed in 48 patients. Right ventricular ejection fraction averaged 0.52 ± 0.08 and was normal in 28 patients. Response of right ventricular ejection fraction to afrerload stress was abnormal in 12 of 14 patients tested. Right ventricular ejection fraction increased normally during exercise in 6 patients, but was abnormal in 15. Mild tricuspid regurgitation was noted in 12 patients. Mild obstruction of the superior caval vein was noted in 4 patients. Baffle leak requiring reoperation occurred in one patient. Fifty-seven of 90 patients are in sinus rhythm by latest electrocardiogram. Postoperative electrophysiologic studies were performed in 34 patients, and Holter monitoring in 25. Significant arrhythmia occurred in 26 patients: 6 patients required pacemakers for slow junctional rhythm or complete heart block; 20 additional patients have a junctional rhythm. Six patients have delayed sinus nodal recovery time. At last follow-up, 88 children (98%) are in New York Heart Association functional Class I, and 2 (2%) are in Class II. The Senning operation for compete transposition can be accomplished with a low operative and late mortality. Serious baffle complications requiring reoperation are rare. Surviving patients are clinically well, but arrhythmias and depressed right ventricular function may limit their long-term functional status.

scholarly journals P971 The echocardiographic phenotype in patients with cardiac amyloidosis and heart failure with preserved ejection fraction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M D M Perez Gil ◽  
V Mora Llabata ◽  
A Saad ◽  
A Sorribes Alonso ◽  
V Faga ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Amyloidosis ◽  
Nyha Class ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction ◽  
Apical Rotation ◽  
Dynamic Torsion

Abstract BACKGROUND New echocardiographic phenotypes of heart failure (HF) are focused on myocardial systolic involvement of the left ventricle (LV), either endocardial and/or transmural. PURPOSE. To study the pattern of myocardial involvement in patients (p) with HF with preserved left ventricular ejection fraction (pLVEF) and cardiac amyloidosis (CA). METHODS. Comparative study of 16 p with CA and HF with pLVEF, considering as cut point LVEF &gt; 50%, in NYHA class ≥ II / IV, and a control group of 16 healthy people. Longitudinal Strain (LS) and Circumferential Strain (CS) were calculated using 2D speckle-tracking echocardiography, along with Mitral Annulus Plane Systolic Excursion (MAPSE) and Base-Apex distance (B-A). Also, the following indexes were calculated: Twist (apical rotation + basal rotation, º); Classic Torsion (TorC): (twist/B-A, º/cm); Torsion Index (Tor.I): (twist/MAPSE, º/cm) and Deformation Index (Def.I): (twist/LS, º). We suggest the introduction of these dynamic torsion indexes as Tor.I and Def.I that include twist per unit of longitudinal systolic shortening of the LV instead of using TorC which is the normalisation of twist to the end-diastolic longitudinal diameter of the LV. RESULTS There were no differences of age between the groups (68.2 ± 11.5 vs 63.7 ± 2.8 years, p = 0.14). Global values of LS and CS were lower in p with CA indicating endocardial and transmural deterioration during systole, while TorC and Twist of the LV remained conserved in p with CA. However, there is an increase of dynamic torsion parameters such as Tor.I and Def.I that show an increased Twist per unit of longitudinal shortening of the LV in the CA group (Table). CONCLUSIONS In p with CA and HF with pLVEF, the impairment of LS and CS indicates endocardial and transmural systolic dysfunction. In these conditions, LVEF would be preserved at the expense of a greater dynamic torsion of the LV. Table LS (%) CS (%) Twist (º) TorC (º/cm) Tor.I (º/cm) Def.I (º/%) CA pLVEF (n = 16) -11.7 ± 4.2 17.2 ± 4.8 19.8 ± 8.3 2.5 ± 1.1 27.7 ± 13.5 -1.8 ± 0.9 Control Group (n = 15) -20.6 ± 2.5 22.7 ± 4.9 21.7 ± 6.1 2.7 ± 0.8 16.4 ± 4.7 -1.0 ± 0.3 p &lt; 0.001 &lt; 0.01 0.46 0.46 &lt; 0.01 &lt; 0.01 Dynamic Torsion Indexes and Classic Torion Parameters in pLVEF CA patients vs Control group.

scholarly journals The Value of 4D Speckle-Tracking Strain Echocardiography in Evaluating the Relationship Between Asprosin and Growth Differentiation Factor-15 Levels and Subclinical Systolic Dysfunction in Patients With Acromegaly and Prolactinoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A650-A651
Author(s):  
Busra Firlatan ◽  
Ugur N Karakulak ◽  
Vedat Hekimsoy ◽  
Burcin G Iremli ◽  
Incilay Lay ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Speckle Tracking ◽  
Systolic Dysfunction ◽  
Linear Regression Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction ◽  
Patient Groups ◽  
The Relationship

Abstract Introduction: In patients with acromegaly and prolactinoma, the long-term presence of elevated GH and PRL levels is associated with an unfavorable cardiovascular risk profile. Early recognition of dysfunctions related to cardiovascular complications, which can be a significant contributor to mortality, is important. The aim of this study was to assess the relationship of four-dimensional speckle-tracking strain echocardiographic (4DSTE) measurements with asprosin, GDF-15 levels, and the Framingham cardiovascular risk score (FRS) in patients with acromegaly and prolactinoma. Methods: The study included 41 acromegaly [20F/21M, age: 49 (41-57)], 29 prolactinoma patients [18F/11M, age: 40 (28-48)] and 33 healthy control subjects [15F/18M, age: 48 (37-54)]. Data are presented as median with interquartile ranges (IQR). Anthropometric, biochemical and echocardiographic measurements were performed. Asprosin and GDF-15 levels were measured by ELISA. Results: Plasma asprosin concentration in the prolactinoma group [2.4 ng/mL (0.0-9.7)] was significantly lower than the concentration in both the acromegaly group [6.8 ng/mL (2.6-9.9)] and the control group [10.2 ng/mL (2.3-18.0)] (p=0.022 and p=0.006, respectively). In the study population, asprosin levels were positively correlated with age, FRS, and GDF-15 levels (r=0.361, p&lt;0.001; r=0.275, p=0.005 and r=0.240, p=0.015; respectively). Plasma GDF-15 concentration was lower in prolactinoma group [262.2 pg/mL (169.3-336.1)] than in the acromegaly [332.5 pg/mL (257.4-438.8)] and control groups [331.3 pg/mL (233.6-428.9)] (p=0.008 and p=0.047, respectively). In multiple linear regression analysis, GDF-15 level was independently positively related to the FRS in both patient groups (p&lt;0.001). FRS was highest in patients with acromegaly (p=0.004). In 2DE; the left ventricular ejection fraction although within normal limits, was lower in acromegaly [63% (63-65)] and prolactinoma [63% (60-65)] patients compared to the healthy controls [66% (63-68)] (p=0.003). In both acromegaly and prolactinoma groups; global longitudinal, circumferential, areal and radial strain measurements identified by 4DSTE were lower than the control group (acromegaly: p=0.007, p=0.008, p=0.015, p=0.008; prolactinoma: p=0.033, p=0.019, p=0.030, p=0.025, respectively). In contrast, diastolic functions were evaluated as normal in 85% of acromegaly patients, 86% of prolactinoma patients, and 93% of the control group (p=0.365). Conclusion: This is the first study to demonstrate the isolated subclinical systolic dysfunction identified by four-dimensional echocardiography in patients with acromegaly and prolactinoma. Asprosin may be associated with cardiovascular diseases in addition to its role in the pathogenesis of type 2 diabetes mellitus, and GDF-15 can be used as a biomarker to predict cardiovascular risk in these patient groups.

scholarly journals Prognostic role of metabolic risk factors (hyperhomocysteinemia) in the development of chronic heart failure

2015 ◽  
Vol 18 (1) ◽  
pp. 20
Author(s):  
Ye. N. Berezikova ◽  
M. G. Pustovetova ◽  
S. N. Shilov ◽  
A. V. Yefremov ◽  
A. T. Teplyakov ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Blood Serum ◽  
Homocysteine Level ◽  
Functional Class ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Group ◽  
Relationship Of ◽  
The Relationship

The aim of the study was to assess the relationship of homocysteine levels in the blood serum with the severity and nature of chronic heart failure (CHF) in patients with coronary heart disease. 94 patients with CHF were examined. The control group included 32 patients without cardiovascular disorders. At baseline and after 12 months of observation the homocysteine levels in the blood serum were determined by enzyme-linked immunosorbent assay. Correlative relationship of hyperhomocysteinemia with ischemic myocardial remodeling and with reduced inotropic function in CHF patients was observed. The homocysteine level in the blood serum of CHF patients significantly exceeded that of the control group and moderately increased with the progression of the disease severity of functional class. In the group with an unfavorable course of CHF the baseline homocysteine level proved to have the greatest value as compared to that in the group with a favorable course. In patients with a favorable course of CHF the homocysteinemia level tended to decrease towards the end of prospective study, whereas in patients with an unfavorable course, on the contrary, hyperhomocysteinemia persisted (p<0.01). In case the hyperhomocysteinemia baseline exceeds 18.5 mkmol/L (ROC-AreaSE = 0.860.04, sensitivity 71 %, specificity 90%), the severity and characteristics of the ischemic CHF could be most likely predicted. Thus, hyperhomocysteinemia is related with the severity and nature of CHF. Determining the level of homocysteine in the blood serum can be recommended for early prediction of the severity and nature of CHF.

Characteristics of Children with Acute Rheumatic Carditis from a High-Incidence Region: Importance of Unexplained Worsening of Functional Class

Cardiology ◽  
2020 ◽  
Vol 145 (8) ◽  
pp. 522-528
Author(s):  
Rajiv Narang ◽  
Anita Saxena ◽  
Sivasubramanian Ramakrishnan ◽  
Saurabh K. Gupta ◽  
Rajnish Juneja ◽  
...  
Keyword(s):  
Nyha Class ◽  
Public Health Problem ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
First Episode ◽  
Major Public Health Problem ◽  
Class Iii ◽  
Rheumatic Carditis ◽  
Ventricular Ejection Fraction

Background: Acute rheumatic fever (ARF) and acute rheumatic carditis (ARC) continue to be a major public health problem in developing countries. Objective: To study the characteristics of children with ARC being treated at a tertiary centre. Methods and Results: We studied 126 children (mean age 10.4 ± 2.3 years, range 5–15 years, 60% males) diagnosed with ARC by treating cardiologists. Most had lower socio-economic status. Fifty of 126 (40%) presented with a first episode of ARC. Joint symptoms were present in 29% and fever in 25%. Only 2.4% had subcutaneous nodules and none had erythema marginatum or chorea. Fifty-one percent presented in NYHA class II and 29% in NYHA class III or IV. Tachycardia and heart failure were present in 53% and 21%, respectively. Recent worsening of NYHA class (dyspnoea) was the commonest feature (48%). Laboratory investigations showed raised antistreptolysin O titres (>333 units) in only 36.7% of patients. Raised C-reactive protein (CRP) was present in 70%, while raised erythrocyte sedimentation rate was found in only 37% of patients. On the basis of above findings, the modified Jones criteria (2015) for the diagnosis of ARF were satisfied only in 46% of children. Echocardiography showed mitral valve thickening in 77% and small nodules on the tip of the leaflets in 43% (27 and 8%, respectively for aortic valve). Left ventricular ejection fraction was <50% in only 3 patients. The dominant valve lesion was mitral regurgitation (MR) (present in 95% of patients; severe in 78%, moderate in 15%), while aortic regurgitation was present in 44% (severe in 14%). Conclusions: The criteria are often not satisfied by patients being treated for ARC. Recent unexplained worsening of dyspnoea, young age, significant MR, echocardiographic nodules, and elevated CRP are important indicators.

Total isovolumic time relates to exercise capacity in patients with transposition of the great arteries late after atrial switch procedures

2011 ◽  
Vol 22 (4) ◽  
pp. 381-389 ◽  
Author(s):  
Edgar L. W. Tay ◽  
Derek Gibson ◽  
Ryo Inuzuka ◽  
Manjit Josen ◽  
Rafael Alonso-Gonzalez ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Exercise Capacity ◽  
Systolic Dysfunction ◽  
Cardiopulmonary Exercise Testing ◽  
Right Ventricular Ejection Fraction ◽  
Peak Oxygen Consumption ◽  
P Value ◽  
Ventricular Ejection Fraction ◽  
Atrial Switch ◽  
Filling Time

AbstractBackgroundSystemic right ventricular systolic dysfunction is common late after atrial switch surgery for transposition of the great arteries. Total isovolumic time is the time that the ventricle is neither ejecting nor filling and is calculated without relying on geometric assumptions. We assessed resting total isovolumic time in this population and its relationship to exercise capacity.MethodsA total of 40 adult patients with transposition of the great arteries after atrial switch – and 10 healthy controls – underwent transthoracic echocardiography and cardiopulmonary exercise testing from January, 2006 to January, 2009. Resting total isovolumic time was measured in seconds per minute: 60 minus total ejection time plus total filling time.ResultsThe mean age was 31.6 plus or minus 7.6 years, and 38.0% were men. There were 16 patients (40%) who had more than or equal to moderate systolic dysfunction of the right ventricle. Intra- and inter-observer agreement was good for total isovolumic time, which was significantly prolonged in patients compared with controls (12.0 plus or minus 3.9 seconds per minute versus 6.0 plus or minus 1.8 seconds per minute, p-value less than 0.001) and correlated significantly with peak oxygen consumption (r equals minus 0.63, p-value less than 0.001). The correlation strengthened (r equals minus 0.73, p-value less than 0.001) after excluding seven patients with exercise-induced cyanosis. No relationship was found between exercise capacity and right ventricular ejection fraction or long-axis amplitude.ConclusionResting isovolumic time is prolonged after atrial switch for patients with transposition of the great arteries. It is highly reproducible and relates well to exercise capacity.

Association of Physical Activity and Prognostic Parameters in Elderly Patients With Heart Failure

2011 ◽  
Vol 19 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Melissa Jehn ◽  
Arno Schmidt-Trucksäss ◽  
Henner Hanssen ◽  
Tibor Schuster ◽  
Martin Halle ◽  
...  
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Nyha Class ◽  
Clinical Status ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure

Objective:Assessment of habitual physical activity (PA) in patients with heart failure.Methods:This study included 50 patients with heart failure (61.9 ± 4.0 yr). Seven days of PA were assessed by questionnaire (AQ), pedometer, and accelerometer and correlated with prognostic markers including VO2peak, percent left-ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and New York Heart Association (NYHA) functional class.Results:Accelerometry showed a stronger correlation with VO2peak and NYHA class (R = .73 and R = −.68; p < .001) than AQ (R = .58 and R = −.65; p < .001) or pedometer (R = .52 and R = −.50; p < .001). In the multivariable regression model accelerometry was the only consistent independent predictor of VO2peak (p = .002). Moreover, when its accuracy of prediction was tested, 59% of NYHA I and 95% of NYHA III patients were correctly classified into their assigned NYHA classes based on their accelerometer activity.Conclusion:PA assessed by accelerometer is significantly associated with exercise capacity in patients with heart failure and is predictive of disease severity. The data suggests that PA monitoring can aid in evaluating clinical status.

scholarly journals Association of mean platelet volume with echocardiographic findings in patients with severe rheumatic mitral stenosis

2019 ◽  
Vol 11 (2) ◽  
pp. 95-99 ◽  
Author(s):  
Naser Aslanabadi ◽  
Ahmad Separham ◽  
Leyla Valae Hiagh ◽  
Farid Karkon Shayan ◽  
Mehrnoush Toufan ◽  
...  
Keyword(s):  
Mean Platelet Volume ◽  
Mitral Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Healthy Individuals ◽  
Platelet Volume ◽  
Ventricular Ejection Fraction ◽  
Rheumatic Mitral Stenosis ◽  
Echocardiographic Findings

Introduction: Rheumatic heart disease (RHD) is a relatively common cause of mortality among patients in the developing countries, and pure mitral valve failure is the most common form of RHD. An increase in the mean platelet volume (MPV) is considered as an independent risk factor for many cardiovascular diseases. This study aimed to evaluate the association of MPV with echocardiographic findings in patients with severe rheumatic mitral stenosis. Methods: In a descriptive, analytical study, 100 patients with severe rheumatic mitral stenosis referred to Shahid Madani hospital of Tabriz University of Medical Sciences and 100 age & sex-matched healthy individuals were included the study. MPV and echocardiographic findings including Wilkins score, left ventricular ejection fraction (LVEF), pulmonary artery systolic pressure, and left atrial spontaneous echo contrast (LASEC) were evaluated in both groups. Results: MPV in the case group was 10.45±0.98 and in the control group was 9.88±0.83. MPV in the patient’s groups was significantly higher than the control group (P = 0.001). Also, MPV in patients with positive LASEC findings was 10.69 ± 1.01 and in patients with negative LASEC findings was 10.25 ± 0.91. The difference was found to be statistically significant (P = 0.028). Conclusion: Patients with rheumatic mitral stenosis has a higher MPV compared to the healthy individuals, and it is associated with LASEC sign seen in echocardiography.

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