Thorac Cardiovasc Surg 2013; 61 - P19
DOI: 10.1055/s-0033-1354508

Symmetrical Dimethylarginine Is a Better Biomarker for Systemic Ventricular Dysfunction in Adults after Atrial Repair for Transposition of the Great Arteries Than NT-proBNP

O Tutarel 1, P Röntgen 1, SM Bode-Böger 2, J Martens-Lobenhoffer 2, M Westhoff-Bleck 1, GP Diller 3, J Bauersachs 1, JT Kielstein 4
  • 1Cardiology & Angiology, Hannover Medical School
  • 2Institute for Clinical Pharmacology, Otto-von-Guericke University, Magdeburg
  • 3Adult Congenital and Valvular Heart Disease Center, University Hospital Münster
  • 4Nephrology & Hypertension, Hannover Medical School

Background: Asymmetrical dimethylarginine (ADMA) and its structural isomer symmetrical dimethylarginine (SDMA) were identified as biomarkers for heart failure of noncongenital origin. ADMA is also more sensitive than NT-proBNP in diagnosing heart failure in general adult congenital heart disease patients. The role of both biomarkers in patients with a systemic right ventricle after atrial repair for transposition of the great arteries (D-TGA) has not been evaluated.

Methods: In 45 patients (mean age 29.4 ± 3.5 y, female 17 [37.8%]) SDMA, ADMA, and NT-proBNP levels were measured and correlated to clinical parameters, parameters assessed by magnetic resonance imaging, and cardiopulmonary exercise testing.

Results: SDMA correlated significantly with systemic ventricular ejection fraction (RVEF): r=– 0.40, p= 0.007. ADMA (r= 0.09, p= 0.54) and NT-proBNP (ρ= 0.28, p= 0.06) showed no correlation with RVEF. Additionally, SDMA distinguished between patients with a severely reduced, moderately reduced, and normal RVEF. Further, SDMA showed a strong correlation with QRS duration (ρ= 0.51, p= 0.0004), while ADMA (ρ= 0.14, p= 0.35) and NT-proBNP (ρ= 0.27, p= 0.07) did not. Furthermore, SDMA was elevated in patients with a broad QRS complex (≥120 ms) compared with patients with a QRS complex < 120 ms.

Conclusion: SDMA is a superior biomarker of systemic ventricular dysfunction in patients after atrial repair for D-TGA compared with NT-proBNP. The promising role of SDMA in this selected patient population needs to be confirmed in larger studies.