OBJECTIVEWe aimed to investigate the relation of NT-pro BNP level and left ventricular ejection fraction with premature ventricular complex burden.PATIENTS AND METHODSA total of 94 patients with PVC burden > 5% (age 45.9+12.9 years, 53 males, 41 females) were included in the study. The primary outcome was PVC burden % and main prognostic factors were LVEF% and NT-Pro BNP level. Gender, age, DM, HTN, presence of symptoms, symptom duration and heart rate were used as adjustment predictor variables. We created four different linear multivariable models to compare performance measures of prognostic factors: Model-1 has gender, age, DM, HTN, symptoms and heart rate, while LVEF has been added in addition to model-1 in model-2. Model-3 included NT-Pro-BNP alongside model-1 variables, while model-4 included both LVEF and NT-Pro-BNP variables in addition to model-1 variables. Accordingly, we compare the performance (R2, likelihood ratio X2) of models.RESULTSThe median PVC burden was 18% (IQR; 11-27). When model-1 consisting of gender, age, DM, HTN, presence of symptoms, symptomS duration and heart rate and model-2 consisting of LVEF in addition to variables of model-1 were compared, it was observed that both LRX2 and R2 values improved (likelihood ratio test p-value=0.013). Model-1 compared with model-3 which consisting of NT-pro BNP in addition to variables of model-1, and it was observed that both LRX2 and R2 values improved (likelihood ratio test p-value=0.008). However, when compared to model-1, the most significant improvement was observed in both LRX2 and R2 values in model-4 consisting of model-1 plus NT-Pro-BNP and LVEF (likelihood ratio test p-value <0.001).CONCLUSIONSWe determined that NT-pro-BNP levels and LVEF could predict PVC burden in patients. Higher levels of NT-pro-BNP and lower LVEF values were associated with increased PVC burden.

A 31-year-old woman was admitted to our emergency service with dyspnea and palpitation. On physical examination her blood pressure was 90/60 mmHg and heart rate 160 per/minute. Electrocardiogram showed supraventricular tachycardia. After an 6 mg bolus of adenosin, sinusal rythm was achieved. Her heart auscultation revealed a harsh systolic murmur at the upper left sternal border and a pansystolic murmur at the left ventricle apex. Two-dimensional echocardiography showed Double outlet right ventricle (DORV) with sub-aortic ventricular septal defect (VSD) and pulmonary stenosis that mimicking tetralogy of Fallot (TOF) (Figure 1). Cardiac computed tomography (CT) imaging was performed to fully delineate the underlying cardiac anatomy, as there was limited acoustic window for echocardiography. CT, showed following both great arteries arising from the morphologically right ventricle, anterior and right-sided aorta, with subaortic VSD and infundibular pulmonary stenosis (Figure 2,3,4). DORV with anterior right-sided aorta, sub aortic VSD and posterior-sided pulmonary artery was diagnosed. Diagnostic cardiac catheterization showed following mean pulmonary artery pressure (13 mmHg), right ventricle pressure (30/10 mmHg), left ventricle pressure (90/8 mmHg). The Rastelli operation was suggested to our patient but she denied operation and discharged from the hospital. The diagnosis of DORV is challenging because of anatomical heterogeneity and difficulties in clinical classification with problems concerning surgical timing and the choice of appropriate technique. Multimodality cardiac imaging using echocardiography, cardiac CT and cardiac catheterization should be used for complete characterization of complex congenital heart anomalies in adulthood.