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The syndrome of cardiac failure in adults with congenitally corrected transposition*

Published online by Cambridge University Press:  01 December 2008

Mirta Koželj ,
Katja Prokšelj ,
Pavel Berden ,
Matevž Jan ,
Joško Osredkar ,
Matjaž Bunc ,
Martin Tretjak  and
Tomaž Podnar
Mirta Koželj*
Affiliation:
Department of Cardiology, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
Katja Prokšelj
Affiliation:
Department of Cardiology, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
Pavel Berden
Affiliation:
Institute of Radiology, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
Matevž Jan
Affiliation:
Department of Cardiology, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
Joško Osredkar
Affiliation:
Clinical Institute of Clinical Chemistry and Biochemistry, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
Matjaž Bunc
Affiliation:
Department of Cardiology, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
Martin Tretjak
Affiliation:
Department of Internal Medicine, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
Tomaž Podnar
Affiliation:
Department of Paediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
*
Correspondence to: Prof. Mirta Koželj, MD, PhD, FESC, Department of Cardiology, University Medical Centre Ljubljana, Zaloška 7, 1525 Ljubljana, Slovenia. Tel: +386 (0) 1 522 31 25; Fax: +386 (0) 1 522 28 28; E-mail: mirta.kozelj@mf.uni-lj.si
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Abstract

Objectives

To assess neurohormonal activation of cardiac failure in adults with congenitally corrected transposition, and to determine the most sensitive marker for recognition of the cardiac failure.

Background

The onset of morphologically right ventricular dysfunction is unpredictable in patients with congenitally corrected transposition, the combination of discordant atrioventricular and ventriculo-arterial connections, and its markers are unknown.

Methods

We measured amino terminal pro brain natriuretic peptide in 19 patients, aged 35 plus or minus 13.1 years, and in 19 control subjects. Morhologically right ventricular function was assessed by echocardiography, including tissue Doppler echocardiography and magnetic resonance imaging or multislice computed tomography.

Results

The patients showed a highly significant increase in the levels of amino terminal pro brain natriuretic peptide, the levels being significantly elevated even in asymptomatic patients. Left atrial dimensions were larger in patients, and significantly lower tissue Doppler echocardiographic velocities were measured at the lateral site of the tricuspid annulus and at the basal segment of the interventricular septum. The ejection fraction of the morphologically right ventricle correlated significantly with the levels of brain natriuretic peptide, and with left atrial dimensions.

Conclusions

Neurohormonal activation is present in patients with congenitally corrected transposition even when they are asymptomatic. It is correlated with left atrial dimensions and tissue Doppler echocardiographic parameters. Levels of brain natriuretic peptide, and peak tricuspid early diastolic annular velocity, are the earliest and most sensitive markers of morphologically right ventricular dysfunction.

Keywords

Adult congenital heart diseasetissue doppler echocardiographyamino terminal pro brain natriuretic peptide
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 6 , December 2008 , pp. 599 - 607
Copyright
Copyright © Cambridge University Press 2008

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Footnotes

*

Grants and other finacial support: the study was supported by Roche Diagnostics GmbH Mannheim, Germany and Krka d.d., Novo mesto, Slovenia.

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