Key result
Serum NT-pro-BNP was a strong predictor for reoperation in children with surgically corrected Tetralogy of Fallot, demonstrating an area under the curve of 0.950 with 88.9% sensitivity and 91.8% specificity.
Why the study?
Does NT-pro-BNP predict the need for reoperation in children with surgically corrected Tetralogy of Fallot?
Observational (n=111)
No
Does NT-pro-BNP predict the need for reoperation in children with surgically corrected Tetralogy of Fallot?
Effect estimate: AUC 0.950
p-value: p=<0.001
NT-pro-BNP is a highly sensitive and specific biomarker for predicting the need for pulmonary valve replacement in children with surgically repaired Tetralogy of Fallot.
NT-pro-BNP may aid reoperation risk stratification in repaired TOF; leaves open prospective validation before practice change.
BACKGROUND: Most patients with surgically corrected tetralogy of Fallot (TOF) are faced with multiple residua and sequelae such as pulmonary regurgitation (PR), resulting in reoperation for pulmonary valve replacement (PVR). Plasma brain natriuretic peptide (BNP) level and serum N-terminal pro-BNP (NT-pro-BNP) level are useful as diagnostic objective markers of chronic heart failure (CHF). The aim of the study was to examine whether these markers have predictive ability for reoperation in children with surgically corrected TOF. METHODS AND RESULTS: Fifty-eight patients (38 male, 20 female) aged 1-18 years (median, 7 years) were enrolled. Serum NT-pro-BNP in TOF patients was significantly higher than in age-matched hospital controls without CHF (359.5±449.7pg/ml vs. 86.1±45.1pg/ml, respectively; P<0.0001). BNP and NT-pro-BNP had a better correlation with CHF index, RVEDP, and LVEDV in TOF groups. Children with surgically corrected TOF who had indication for PVR had higher BNP and NT-pro-BNP and more severe PR than those without indication for PVR. On multivariate logistic regression analysis, NT-pro-BNP was the strongest predictor for reoperation in patients with surgically corrected TOF. Area under the curve of NT-pro-BNP for reoperation was 0.950 (P<0.001) with a sensitivity of 88.9% and specificity of 91.8%. CONCLUSIONS: NT-pro-BNP is a good biomarker for monitoring CHF, and is a good predictor of PVR in children with surgically repaired TOF.
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Hirono et al. (2013) conducted an observational in Surgically corrected Tetralogy of Fallot (n=111). Serum NT-pro-BNP vs. Patients without indication for reoperation was evaluated on Reoperation for pulmonary valve replacement (AUC 0.950, p=<0.001). Serum NT-pro-BNP was a strong predictor for reoperation in children with surgically corrected Tetralogy of Fallot, demonstrating an area under the curve of 0.950 with 88.9% sensitivity and 91.8% specificity.
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