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Timing of Dynamic NT-proBNP and hs-cTnT Response to Exercise Challenge in Asymptomatic Children with Moderate Aortic Valve Regurgitation or Moderate Aortic Valve Stenosis

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Abstract

Patients with congenital aortic valve stenosis (AVS) can remain asymptomatic but may develop progressive and often underestimated exercise intolerance. The risk of increased left ventricular (LV) wall stress, irreversible myocardial fibrosis and sudden death in untreated patients warrants earlier intervention. The timing for curative therapy for severe AVS is clear, but optimal timing for moderate stenosis (modAS) is unknown. AVS often coexists with aortic regurgitation, which adds a volume overload to an already pressure-overloaded LV, adding an additional challenge to the estimation of disease severity. We investigated the possible value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) upon treadmill exercise challenge in children with asymptomatic modAS versus moderate regurgitation (modAR). The aim was to determine optimal timing of peak biochemical response. Blood samples were obtained at rest, and then at 20, 40 and 60 min after peak exercise comparing modAS and modAR to healthy controls. Exercise performance was equivalent in all groups, with no difference for biomarker levels at rest. The increase in NT-proBNP was significant in modAR at 40 min (99.2 ± 48.6 ng/L; p = 0.04) and 60 min into recovery (100.0 ± 53.7 ng/L; p = 0.01), but not in modAS. The increase in hs-cTnT was significant only at 60 min into recovery for modAS and modAR. NT-proBNP and hs-cTnT following exercise challenge are possible discriminant biomarkers of modAR from modAS and controls at 60 min into recovery despite comparable exercise performance. This offers a promising avenue for future stratification of aortic valve disease and optimal timing of intervention.

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Acknowledgments

For this Investigator Initiated Proposal, received partial funding, monetary and in kind, from Roche Diagnostics, Switzerland.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, 3175, Cote Sainte-Catherine, Montréal, QC, H3T 1C5, Canada

    Wadi Mawad, Sylvia Abadir, Anne Fournier, Jean-Luc Bigras & Nagib Dahdah

  2. Department of Kinesiology, University of Montréal, Montréal, Canada

    Daniel Curnier

  3. Mechanical and Industrial Engineering Department, Concordia University, Montréal, QC, Canada

    Lyes Kadem

Authors
  1. Wadi Mawad
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  2. Sylvia Abadir
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  3. Anne Fournier
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  4. Jean-Luc Bigras
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  6. Lyes Kadem
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  7. Nagib Dahdah
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Correspondence to Nagib Dahdah.

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Authors have no conflicts of interest to declare.

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This work was completed according to local and international ethics standards for human research. Institutional ethics approval complying with regulations granting proper respect of human rights was granted.

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Mawad, W., Abadir, S., Fournier, A. et al. Timing of Dynamic NT-proBNP and hs-cTnT Response to Exercise Challenge in Asymptomatic Children with Moderate Aortic Valve Regurgitation or Moderate Aortic Valve Stenosis. Pediatr Cardiol 36, 1735–1741 (2015). https://doi.org/10.1007/s00246-015-1225-2

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  • DOI: https://doi.org/10.1007/s00246-015-1225-2

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