The Correlation between Serum Level of NT-Pro Brain Natriuretic Peptide and Hemodynamically Significant Ventricular Septal Defects

Abstract Background Ventricular septal defect (VSD) is the most common congenital heart disease accounting for 40% of all congenital heart diseases. An isolated VSD accounts for more than 20% of all congenital heart diseases. Aim of the Work We aimed in this study to correlate the serum level of NT Pro-BNP with different 2D and 3D variables and the hemodynamic significance of ventricular septal defects including LV volumes, dimensions, functions and left to right shunt quantification (Qp/Qs) measured by 2D echocardiogram. Patients and Methods Our study included 60 patients in the pediatric age group (up to18 years old) who were referred for elective echocardiogram in the congenital and structural heart disease unit cardiology department in Ain Shams University hospital. Patients with VSD were divided into three equal subgroups according to shunt quantification (Qp/Qs): group (1) included patients with (Qp/Qs <1.5), group (2) included patients with (Qp/Qs>1.5-2) and group (3) included patients with (Qp/Qs >2). Results There was a highly significant positive correlation between Pro-BNP level and echocardiographic shunt quantification by QP_QS (p < 0.001). And there was a highly significant positive correlation between Pro-BNP and echocardiographic VSD Size (r = 0.8) & Mean. PAP (0.8). A highly significant positive correlation between Pro-BNP and indexed LVEDV and indexed LVESV by 2D and 3D echocardiography was also noticed. Also there was a highly significant negative correlation between Pro- BNP and EF by m mode and a significant negative correlation with LV EF by Simpsons method and LV EF by 3D echocardiography. In our study with ROC curve analysis a cut-off point of discriminating patients with QP/QS <1.5 from those >1.5 was 98 pg/ml that had the highest balanced sensitivity and specificity to predict significant shunt with sensitivity = 97.5 % and specificity = 90 %. Conclusion Pro-BNP level correlates with the amount of left to right shunt (Qp/Qs ratio) in children with VSD. Therefore, pro-BNP can be used as a screening tool for evaluating hemodynamic load in these patients.