Open Access

ARTICLE

NT-proBNP predicts mortality in adults with transposition of the great arteries late after Mustard or Senning correction

Jana Rubáčková Popelová, MD1,2 | Markéta Tomková1,3 | Jakub Tomek1,4

1 Department of Cardiac Surgery, Hospital Na Homolce, Prague, Czech Republic
2 Pediatric Heart Centre, Faculty Hospital Motol, Prague, Czech Republic
3 Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
4 Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom

* Corresponding Author: Jana Rubáčková Popelová, Hospital Na Homolce, Department of Cardiac Surgery, Roentgenova 2, 15030 Prague 5, Czech Republic, Europe. Email:

Congenital Heart Disease 2017, 12(4), 448-457. https://doi.org/10.1111/chd.12466

Abstract

Objective: The patients after Mustard and Senning corrections of transposition of the great arteries (TGA) are at an increased risk of unexpected death. The aim of this study was to identify markers allowing risk stratification of patients after atrial switch correction of TGA to provide them with optimum care.
Methods and Results: In this study, 87 patients were retrospectively evaluated after atrial switch correction of TGA followed-up between 2005 and 2015. The mortality during the follow-up was 9% (8 cardiac deaths). Markers significantly predictive of death using univariable Cox proportional hazard ratio survival analysis were: N-terminal pro-B-type natriuretic peptide (NT-proBNP), ejection fraction and end-diastolic dimension of the systemic right ventricle, mitral E, e' , and s'. Surprisingly, the Doppler parameters of mitral valve in subpulmonary ventricle were more important for prognosis than those of systemic tricuspid valve. In multivariable analysis, the only independent predictors of mortality were NT-proBNP (P = .00048; AUC 0.97) and the velocity of early diastolic filling (mitral E) in subpulmonary ventricle (P = .01815; AUC 0.81). According to Kaplan–Meier survival analysis, patients with NT-proBNP> 1000 pg/ml are at high risk of death. Patients with mitral E< 68 cm/s are also at an increased risk of death.
Conclusions: NT-proBNP is the most reliable prognostic mortality factor and should be measured regularly in TGA patients after Mustard or Senning correction. Diastolic filling velocity of the subpulmonary left ventricle (mitral E) may be more important for prognosis than systolic function of the systemic right ventricle.

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