Could NT-PROBNP predict cardiac involvement in children with duchenne muscular dystrophy as detected by real-time three-dimensional (four-dimensional) and speckle-tracking echocardiography?

Aim: Cardiac complications significantly contribute to mortality in Duchenne Muscular Dystrophy (DMD) patients. Early detection of cardiac involvement is crucial for optimizing therapeutic interventions. This study aimed to evaluate the role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in detecting cardiac involvement, as assessed by real-time three-dimensional (four-dimensional) and speckle-tracking echocardiography, in patients diagnosed with DMD. Material and Methods: This cross-sectional study enrolled individuals under 21 years with confirmed DMD diagnosis, devoid of comorbidities. Participants underwent clinical evaluation, four-dimensional and speckle-tracking echocardiography, and simultaneous measurement of serum NT-proBNP levels. Correlation analysis between echocardiographic parameters and NT- proBNP was performed. Results: The study comprised 38 DMD patients with a mean age of 9.40 ± 4.13 years. Systolic dysfunction (ejection fraction <55%) was evident in 30% (n=12) of patients. Moderate significant correlations were observed between NT-proBNP levels and various echocardiographic parameters, including basal anterolateral and inferolateral longitudinal strain, apical septal longitudinal strain and bazal anterolateral and inferolateral radial strain (p<0.05). Subgroup analysis based on NT-proBNP levels (<125 pg/ml vs. ≥125 pg/ml) revealed impaired basal anterolateral longitudinal strain in the high NT-proBNP group. Furthermore, moderate to high correlations (r>0.5) were noted between age and both all global and 70% of regional contraction parameters (p<0.05). Conclusion: This is the first study that includes NT-proBNP in conjunction with four- dimensional and speckle tracking echocardiography for assessing cardiac involvement in DMD patients. The observed correlations between NT-proBNP levels and regional contraction parameters show its relevance as a biomarker for cardiac dysfunction. The integration of NT- proBNP and four-dimensional and speckle tracking echocardiography into routine clinical practice holds promise for optimizing therapeutic strategies and improving outcomes in this patient population. Keywords: duchenne muscular dystrophy, NT-proBNP, three dimensional echocardiography, four dimensional echocardiography, speckle-tracking echocardiography