Research: Right Heart Strain, Brain Natriuretic Peptide, and Mortality in Congenital Diaphragmatic Hernia

Ann Am Thorac Soc

. 2020 Jul 30. doi: 10.1513/AnnalsATS.201910-767OC. Online ahead of print.

Right Heart Strain, Brain Natriuretic Peptide, and Mortality in Congenital Diaphragmatic Hernia

Catherine M Avitabile 1 2Yan Wang 1Xuemei Zhang 1Heather Griffis 3Sofia Saavedra 1Samantha Adams 1Lisa Herkert 1David B Frank 4Michael D Quartermain 1 5Natalie E Rintoul 1 5Holly L Hedrick 1Laura Mercer-Rosa 1Affiliations expand


Rationale: Brain natriuretic peptide correlates with pulmonary hypertension by echocardiogram in congenital diaphragmatic hernia, however its association with right ventricular function and mortality is unknown.

Objective: To characterize the relationships between echocardiogram-derived right ventricular strain, brain natriuretic peptide, and mortality in diaphragmatic hernia.

Methods: We performed a single-center, retrospective cohort study of infants with diaphragmatic hernia and at least one brain natriuretic peptide-echocardiogram pair within a 24-hour period. Right ventricular global longitudinal and free wall strain were measured on existing echocardiograms. Associations between strain, brain natriuretic peptide, and mortality were tested using mixed effect linear and logistic regression models. Survival analysis was stratified by brain natriuretic peptide and strain abnormalities.

Results: There were 220 infants with 460 brain natriuretic peptide-echocardiogram pairs obtained pre-op (n=237), ≦1 week post-op (n=35), and >1 week post-op (“recovery,” n=188). Strain improved after repair (p<0.0001 for all periods). Higher brain natriuretic peptide was associated with worse strain in recovery but not pre- or immediately post-op [Estimate (95% CI) for recovery: global longitudinal 1.03 (0.50, 1.57), p=0.0003; free wall 0.62 (0.01, 1.22), p=0.047]. BNP and strain abnormalities were associated with extracorporeal membrane oxygenation requirement. Higher brain natriuretic peptide in recovery was associated with greater mortality [OR: 11.2 (1.2, 571.3), p=0.02]. Abnormal strain in recovery had high sensitivity to detect mortality (100% global longitudinal, 100% free wall) but low specificity (28% global longitudinal, 48% free wall).

Conclusions: Persistent RV dysfunction after congenital diaphragmatic hernia repair may be detected by high brain natriuretic peptide level and abnormal RV strain.

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