Related Experiment Video
Updated: Oct 10, 2025
Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Characterization of Circulating and Urinary Biomarkers in the Fontan Circulation and Their Correlation With Cardiac
Sunil J Ghelani1, Alexander R Opotowsky1, David M Harrild1
1Department of Cardiology; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Insights
Biomarkers like NT-proBNP are common in Fontan circulation patients and can detect heart dysfunction. N-terminal pro-B-type natriuretic peptide (NT-proBNP) may identify patients with ventricular dilation or dysfunction.
Area of Science:
- Cardiology
- Biomarker Research
- Pediatric Heart Disease
Background:
- Circulating biomarkers are crucial for heart failure risk stratification but understudied in Fontan patients.
- Ventricular dilation and dysfunction are key imaging predictors of adverse outcomes in this population.
Purpose of the Study:
- To investigate the role of circulating biomarkers in assessing ventricular function in adults with Fontan circulation.
- To correlate novel biomarkers with imaging findings of ventricular dilation and dysfunction.
Main Methods:
- 82 patients with Fontan circulation underwent cardiac MRI and provided blood/urine samples.
- Conventional and novel biomarkers, including NT-proBNP and troponin T, were measured.
- Correlations between biomarkers and imaging parameters (ventricular dilation, ejection fraction) were analyzed.
Main Results:
- N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T strongly correlated with ventricular dilation and dysfunction.
- NT-proBNP >100 pg/ml showed 91% sensitivity for significant ventricular dilation and 82% for reduced ejection fraction (<50%).
- Urinary neutrophil gelatinase-associated lipocalin-2 to creatinine ratio correlated with ejection fraction and GFR.
Conclusions:
- Abnormal heart failure biomarkers are prevalent in ambulatory Fontan patients, even if asymptomatic.
- NT-proBNP is a sensitive biomarker for identifying ventricular dilation or dysfunction in this cohort.
- Further research is needed to integrate these biomarkers into clinical practice for Fontan circulation management.
Abstract:
Several circulating biomarkers have been found to play a role in the surveillance and risk stratification of heart failure without congenital heart disease, but these have not been widely studied in patients with single ventricles palliated with a Fontan operation. Imaging predictors of worse outcomes in this population include ventricular dilation and dysfunction. Patients who weighed >30 kg with a Fontan circulation referred for cardiac magnetic resonance imaging were invited to participate in the study. Blood and urine samples were obtained at the time of imaging and multiple conventional and novel biomarkers were measured. A total of 82 patients with a median age of 18 years were enrolled. Among the novel biomarkers, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T had the strongest correlation with ventricular dilation and dysfunction. NT-ProBNP >100 pg/ml has a sensitivity of 91% for the detection of significant ventricular dilation (end-diastolic volume >120 ml/body surface area1.3) and 82% for detection of ejection fraction <50%. The urinary neutrophil gelatinase-associated lipocalin-2 to creatinine ratio correlated with ejection fraction and estimated glomerular filteration rate. In conclusion, abnormalities in biomarkers of heart failure are common in ambulatory, largely asymptomatic patients with Fontan circulation. NT-ProBNP may serve as a sensitive marker for the identification of patients with significant ventricular dilation or dysfunction. Further work is needed to understand how these easily measured circulating biomarkers may be integrated into clinical care.
More Related Videos
06:29Wireless Telemetry Device Implantation in a Fontan Ovine Model for Continuous and Long-Term Hemodynamic Monitoring
Published on: May 2, 2025
06:02Anatomical Reconstructions of the Human Cardiac Venous System using Contrast-computed Tomography of Perfusion-fixed Specimens
Published on: April 18, 2013
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...
01:28Imaging Studies for Cardiovascular System V: CT
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...