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Utility of biomarkers in adult Fontan patients with decompensated heart failure

Published online by Cambridge University Press:  02 June 2020

Vidang P. Nguyen Open the ORCID record for Vidang P. Nguyen [Opens in a new window] ,
Song Li ,
Stephen J. Dolgner ,
Zachary L. Steinberg  and
Jonathan Buber
Vidang P. Nguyen*
Affiliation:
Department of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
Song Li
Affiliation:
Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
Stephen J. Dolgner
Affiliation:
Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, WA, USA Department of Pediatrics, Seattle Childrens Hospital, Seattle, WA, USA
Zachary L. Steinberg
Affiliation:
Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
Jonathan Buber
Affiliation:
Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
*
Author for correspondence: Vidang Nguyen, Department of Cardiology, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Third Floor Cardiology, Room A3308, Los Angeles, CA, USA. Tel: +1 206 330 1762; Fax: +1 424 315 2880. E-mail: vidangnguyen@gmail.com
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Abstract

Background:

The incidence of heart failure is increasing within the Fontan population. The use of serological markers, including B-type natriuretic peptide, has been limited in this patient population.

Methods:

This was a single-centre retrospective study of Fontan patients in acute decompensated heart failure. Fontan patients underwent a 1:2 match with non-Fontan patients for each heart failure hospitalisation for comparative analysis. A univariate logistic regression model was used to assess associations between laboratory and echocardiographic markers and a prolonged length of stay of 7 days or greater.

Results:

B-type natriuretic peptide levels were significantly lower in Fontan patients admitted for heart failure than that in non-Fontan patients [390.9 (±378.7) pg/ml versus 1245.6 (±1160.7) pg/ml, respectively, p < 0.0001] and were higher in Fontan patients with systemic ventricular systolic or diastolic dysfunction than that in Fontan patients with normal systemic ventricular function [833.6 (±1547.2) pg/ml versus 138.6 (±134.0) pg/ml, p = 0.017]. The change from the last known outpatient value was smaller in Fontan patients in comparison with non-Fontan patients [65.7 (±185.7) pg/ml versus 1638.0 (±1444.7) pg/ml, respectively, p < 0.0001]. Low haemoglobin and high blood urea nitrogen levels were associated with a prolonged length of stay.

Conclusion:

B-type natriuretic peptide levels do not accurately reflect decompensated heart failure in Fontan patients when compared to non-Fontan heart failure patients and should, therefore, be used with caution in this patient population.

Keywords

B-type natriuretic peptidebiomarkercongestive heart failureFontan
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 7 , July 2020 , pp. 955 - 961
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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