State-of-the-Art Paper
The Usefulness of Brain Natriuretic Peptide in Complex Congenital Heart Disease: A Systematic Review

https://doi.org/10.1016/j.jacc.2012.02.092Get rights and content
Under an Elsevier user license
open archive

Brain natriuretic peptide (BNP) and N-terminal pro–brain natriuretic peptide (NT-proBNP) are well-established markers for heart failure in the general population. However, the value of BNP as a diagnostic and prognostic marker for patients with structural congenital heart disease (CHD) is still unclear. Therefore, the purpose of this study was to evaluate the clinical utility of BNP in patients with CHD. We executed a PubMed literature search and included 49 articles that focused on complex congenital heart defects such as tetralogy of Fallot, systemic right ventricle, and univentricular hearts. Data on BNP measurements and cardiac function parameters were extracted. In all patients after correction for tetralogy of Fallot, BNP levels were elevated and correlated significantly with right ventricular end-diastolic dimensions and severity of pulmonary valve regurgitation. Patients with a systemic right ventricle had elevated BNP levels, and positive correlations between BNP and right ventricular function were seen. In patients with a univentricular heart, elevated BNP levels were observed before completion of the Fontan circulation or when patients were symptomatic; a clear association between BNP and New York Heart Association functional class was demonstrated. In conclusion, this review shows an overall increase in BNP values in complex CHD, although differences between types of congenital heart anomaly are present. As BNP values differ widely, conclusions for individual patients should be drawn with caution. Further investigation with sequential BNP measurement in a large, prospective study is warranted to elucidate the prognostic value of BNP assessment in patients with CHD.

Key Words

adverse events
brain natriuretic peptide
cardiac function
congenital heart disease
NT-proBNP

Abbreviations and Acronyms

BNP
brain natriuretic peptide
CHD
congenital heart disease
CMR
cardiac magnetic resonance
LV
left ventricle
NT-proBNP
N-terminal pro–B-type natriuretic peptide
NYHA
New York Heart Association
RV
right ventricle
TCPC
total cavopulmonary connection
TGA
transposition of the great arteries
TOF
tetralogy of Fallot
TR
tricuspid valve regurgitation

Cited by (0)

The authors have reported they have no relationships relevant to the contents of this paper to disclose.