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Burger AL, Hauser JA, Kaider A, Stojkovic S, Diedrich A, Michel-Behnke I, Huber K, Wojta J, Pezawas T, Demyanets S. Direct comparison of the diagnostic performance of growth differentiation factor 8 in pediatric versus adult heart failure. Clin Chim Acta 2024; 557:117883. [PMID: 38521162 DOI: 10.1016/j.cca.2024.117883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Growth differentiation factor 8 (GDF-8, myostatin) has been proposed for the management of adult heart failure (HF). Its potential role in pediatric HF patients is unknown. We sought to investigate its diagnostic performance in adult versus pediatric HF. METHODS GDF-8 was measured prospectively in pediatric and adult HF patients and in matching controls. HF was defined as the combination of typical symptoms and impaired left ventricular systolic function. Diagnostic performance for the detection of HF was evaluated by receiver operating characteristic (ROC) analysis. RESULTS We enrolled 137 patients with HF (85 pediatric) and 67 healthy controls (47 pediatric). Neither pediatric nor adult HF patients had significantly different GDF-8 levels compared to the reference groups (3.53 vs 3.46 ng/mL, p = 0.334, and 6.87 vs 8.15 ng/mL, p = 0.063, respectively), but pediatric HF patients had significantly lower GDF-8 levels compared to adult patients (p < 0.001). ROC analysis showed no significant improvement adding GDF-8 to NT-proBNP, age and sex (area under the curve (AUC): 0.870 vs 0.868, p = 0.614) in children and neither in addition to age nor sex in adult HF patients (AUC: 0.74 vs 0.62, p = 0.110). CONCLUSION GDF-8 did not accurately differentiate between HF patients and normal comparators in neither adults nor in children.
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Affiliation(s)
- Achim Leo Burger
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria
| | - Jakob A Hauser
- Department of Paediatrics and Adolescent Medicine, Division of Paediatric Cardiology, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kaider
- Center for Medical Data Science - Institute of Clinical Biometrics, Medical University of Vienna, Vienna, Austria
| | - Stefan Stojkovic
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - André Diedrich
- Departments of Medicine, Division of Clinical Pharmacology, Vanderbilt Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ina Michel-Behnke
- Department of Paediatrics and Adolescent Medicine, Division of Paediatric Cardiology, Medical University of Vienna, Vienna, Austria
| | - Kurt Huber
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria; Sigmund Freud University, Medical School, Vienna, Austria
| | - Johann Wojta
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria; Core Facilities, Medical University of Vienna, Vienna, Austria
| | - Thomas Pezawas
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Svitlana Demyanets
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria; Department of Laboratory Medicine, Clinic Hietzing, Vienna, Austria.
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Ameh A, Brady JJ. Reference intervals for high sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide in children and adolescents on the Siemens Atellica. Clin Chem Lab Med 2024; 0:cclm-2023-0977. [PMID: 38373095 DOI: 10.1515/cclm-2023-0977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVES The cardiac biomarkers high sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are utilised in paediatric healthcare for the diagnosis and prognostic assessment of many conditions including myocarditis, congenital heart disease, multisystem inflammatory syndrome in children (MIS-C) and heart failure. However, the standardised age-related reference intervals, 99th percentile cut-offs and clinical guidelines are not available, making the interpretation of these biomarkers challenging. This study aimed to generate normative data in a paediatric cohort for the Siemens Atellica® IM 1300 analyser. METHODS Residual plasma samples were collected from children aged up to 17 years attending primary care and out-patient settings and with no apparent evidence of cardiac dysfunction, renal dysfunction or other confounders. Reference intervals were generated using the 2.5th-97.5th percentiles, and 99th percentile cut-offs determined according to CLSI EP28-A3c. RESULTS Statistical analysis revealed that partitioning was not required for gender for either biomarker. The reference interval for hs-cTnI for children aged one month to 16 years (n=292, 146 females and 146 males) was <14 ng/L with a 99th percentile cut-off of 19 ng/L. The reference interval for NT-proBNP for children aged one month up to one year was <714 ng/L (n=14) and for children aged 1-16 years (n=339) was <295 ng/L. CONCLUSIONS This is the first paediatric reference interval data generated on the Siemens Atellica® solution. These reference intervals and 99th percentiles will inform clinical decisions in the paediatric cardiology setting.
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Affiliation(s)
- Akoji Ameh
- Department of Biochemistry, Children's Health Ireland at Crumlin, Dublin, Republic of Ireland
| | - Jennifer J Brady
- Department of Biochemistry, Children's Health Ireland at Crumlin, Dublin, Republic of Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Lu Y, Xiong Y, Wen Y, Yang Y, Liu H. Rediscover the predictive capacity of B-type natriuretic peptide applied to neonatal supraventricular tachycardia. BMC Cardiovasc Disord 2023; 23:603. [PMID: 38066422 PMCID: PMC10704628 DOI: 10.1186/s12872-023-03646-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Supraventricular tachycardia (SVT) is one of the most common non-benign arrhythmias in neonates, potentially leading to cardiac decompensation. This study investigated the early risk factors of acute heart failure (AHF) secondary to SVT in neonates, and explored their value in guiding the selection of effective anti-arrhythmic treatment. METHODS A total of 43 newborns diagnosed with and treated for SVT between January 2017 and December 2022 were analyzed. According to the presence of AHF after restoring sinus rhythm in newborns with SVT, they were divided into SVT with AHF group and SVT without AHF group. Clinical data and anti-arrhythmic therapies were analyzed. Risk factors of AHF secondary to SVT in neonates were determined using logistic regression. The cut-off value for predictors of AHF secondary to SVT and demanding of a second-line anti-arrhythmic treatment was determined through receiver operating characteristic (ROC) analysis. RESULTS Time to initial control of tachycardia > 24 h, hyperkalemia, anemia, and plasma B-type natriuretic peptide (BNP) were identified as risk factors of AHF secondary to SVT in neonates. BNP exhibited AUC of 0.80 in predicting AHF, and BNP > 2460.5pg/ml (OR 2.28, 95% CI 1.27 ~ 45.39, P = 0.03) was an independent predictor, yielding sensitivity of 70.6% and specificity of 84.6%. Neonates with BNP > 2460.5pg/ml (37.5% versus 7.4%, P = 0.04) had a higher demand for a second line anti-arrhythmic treatment to terminate SVT, with sensitivity and specificity for BNP in predicting at 75.0%, 71.4%, respectively. CONCLUSIONS BNP could be used to predict an incident of AHF secondary to SVT and a demand of second-line anti-arrhythmic treatment to promptly terminate SVT and prevent decompensation in neonates.
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Affiliation(s)
- Yaheng Lu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China.
- Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, 611731, China.
| | - Ying Xiong
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China.
| | - Yizhou Wen
- Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, 611731, China
| | - Yanfeng Yang
- Department of Pediatric Cardiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, 611731, China
| | - Hanmin Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China
- Key Laboratory of Chronobiology (Sichuan University), National Health Commission of China, Chengdu, China
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Comparison between BNP and NT-proBNP in pediatric populations. Clin Biochem 2022; 109-110:74-78. [PMID: 35940296 DOI: 10.1016/j.clinbiochem.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are essential biomarkers for the evaluation of cardiac pathologies. However, pediatric reference intervals for BNP and NT-proBNP are not well defined and concordance between them in the evaluation of pediatric patients has been poorly described. METHODS Paired BNP and NT-proBNP testing was performed on 311 specimens representing 175 pediatric patients. Pediatric BNP and NT-proBNP reference intervals derived from the literature were used to evaluate concordance of results based on age group and cardiac pathology. RESULTS Deming regression analysis of BNP and NT-proBNP results revealed a slope of 13.63 (95% CI, 10.35-16.92) and y-intercept of -977.8 (-2063-107.2) with a positive Spearman correlation (r = 0.91). By age group, concordance kappa between BNP and NT-proBNP was 1.0 for 0-10 days, 0.23 (0-0.62) for 11-30 days, 0.82 (0.67-0.97) for 31 days-1 year, 0.81 (0.57-1.0) for 1-2 years and 0.73 (0.64-0.86) for 2-18 years. The ratio of NT-proBNP to BNP was lowest in heart transplant patients (ratio, 6.5 [95% CI, 5.1-8.1]) relative to those with heart disease (10.5 [8.8-13.7]) and pulmonary hypertension (14.2 [11.3-16.0]) but no differences in concordance were observed. For serial specimens, 21% displayed inverse, discordant changes in BNP and NT-proBNP results. Review of discordant serial results revealed that kinetics of changes was comparable and unlikely to be clinically significant. CONCLUSIONS There is positive correlation and moderate concordance between BNP and NT-proBNP in the pediatric population studied.
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Takano M, Nagasaki S, Sakuma J, Shimabukuro M, Kotaki H, Nakata M. Association of amniotic fluid natriuretic peptide levels with ductus venosus Doppler flow in recipient twins with twin-to-twin transfusion syndrome : DV flow and NT-proBNP in TTTS recipient twins. J Med Ultrason (2001) 2022; 49:703-708. [PMID: 35841435 DOI: 10.1007/s10396-022-01241-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE This study examined the relationships between fetal quantitative Doppler parameters and amniotic fluid N-terminal prohormone brain natriuretic peptide (afNT-proBNP) levels as a biomarker of the increased cardiac load in recipient twins with twin-to-twin transfusion syndrome (TTTS). METHODS This single-center, prospective study included all monochorionic diamniotic (MD) twin pregnancies that were diagnosed with TTTS and underwent fetoscopic laser surgery. Doppler flow was used to measure the pulsatility index (PI) of the umbilical artery (UA), ductus venosus (DV), and middle cerebral artery (MCA) of each recipient and donor twins. The afNT-proBNP levels of recipient twins were examined at the time of surgery. The Spearman or Pearson correlation coefficients were used to assess the relationships between afNT-proBNP levels and Doppler parameters. RESULTS A total of 150 MD twin pregnancies were included. The afNT-proBNP levels of the recipient twins showed a stronger correlation with the DV-PI (r = 0.637; P < 0.001) of recipient twins than with the UA-PI and MCA-PI of recipient twins. The Doppler parameters of donor twins were scarcely correlated with the afNT-proBNP levels of the recipient twins. CONCLUSION A positive correlation between the DV-PI and afNT-proBNP levels of recipient twins with TTTS was observed. The recipient twin with an increased DV-PI is expected to be under a high cardiac load; therefore, DV-PI is a useful parameter for assessing increased NT-proBNP levels consecutively and noninvasively. CLINICAL TRIAL REGISTRATION This study was registered with Japanese Clinical Trial Registry "UMIN-CTR" ( http://www.umin.ac.jp/ctr/index-j.htm ; trial ID numbers UMIN000024486 and 000037702).
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Affiliation(s)
- Mayumi Takano
- Department of Obstetrics and Gynecology, Faculty of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan.
| | - Sumito Nagasaki
- Department of Obstetrics and Gynecology, Faculty of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan.,Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Junya Sakuma
- Department of Obstetrics and Gynecology, Faculty of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan.,Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Makiko Shimabukuro
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan.,Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Hikari Kotaki
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan.,Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Faculty of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan.,Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan.,Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan
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Lin YL, Hung YL, Shen CM, Chen YC, Hsieh WS. Can NT-proBNP Levels Be an Early Biomarker of Reduced Left Ventricular Ejection Fraction in Preterm Infants? CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9071002. [PMID: 35883986 PMCID: PMC9320069 DOI: 10.3390/children9071002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/06/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022]
Abstract
Background/Objective: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a cardiac natriuretic hormone that cardiomyocytes release in response to ventricular stretch. It helps with the diagnosis of heart failure in adults, but this application in preterm infants has rarely been reported. This study aimed to evaluate whether NT-proBNP could be used for the early detection of reduced cardiac ejection fraction in preterm infants and the optimal timing for NT-proBNP assessment. Design/Methods: This prospective, single-center, observational study enrolled all preterm infants with NT-proBNP measurements from October 2014 to February 2022. They underwent echocardiographic examinations within 48 h of the NT-proBNP measurements. Reduced left ventricular ejection fraction was defined as below 60%. Receiver operator characteristic (ROC) curves were generated to assess the optimal NT-proBNP cutoff point for the early prediction of reduced cardiac ejection fraction. Results: A total of 68 preterm infants were enrolled, with a total of 134 NT-proBNP measurements being available for analysis. Reduced left ventricular ejection fraction was present in seven infants (10.3%) due to various underlying diseases. The NT-proBNP cutoff level for detecting reduced left ventricular ejection fraction was 9248 pg/mL, with 71.4% sensitivity and 60.8% specificity; the area under the curve was 0.623 (95% CI: 0.487~0.760). The threshold for the optimal postnatal age for applying NT-proBNP to detect reduced left ventricular ejection fraction was >2 days of life (AUC: 0.682; 95% CI: 0.518~0.845), with 70% sensitivity and 67.1% specificity. Conclusions: Although the NT-proBNP levels declined dramatically after birth, a NT-proBNP serum level of 9248 pg/mL might be helpful for the early detection of reduced ejection fraction in preterm infants, and the optimal age for detection was after 2 days of life.
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Affiliation(s)
- Ya-Lan Lin
- Department of Pediatrics, Cathay General Hospital, Taipei 106, Taiwan; (Y.-L.L.); (Y.-L.H.); (C.-M.S.); (Y.-C.C.)
| | - Yi-Li Hung
- Department of Pediatrics, Cathay General Hospital, Taipei 106, Taiwan; (Y.-L.L.); (Y.-L.H.); (C.-M.S.); (Y.-C.C.)
- School of Medicine, Fu Jen Catholic University, New Taipei City 24205, Taiwan
- School of Medicine, National Tsing-Hua University, Hsinchu 30013, Taiwan
| | - Chung-Min Shen
- Department of Pediatrics, Cathay General Hospital, Taipei 106, Taiwan; (Y.-L.L.); (Y.-L.H.); (C.-M.S.); (Y.-C.C.)
- School of Medicine, Fu Jen Catholic University, New Taipei City 24205, Taiwan
| | - Yung-Chuan Chen
- Department of Pediatrics, Cathay General Hospital, Taipei 106, Taiwan; (Y.-L.L.); (Y.-L.H.); (C.-M.S.); (Y.-C.C.)
| | - Wu-Shiun Hsieh
- Department of Pediatrics, Cathay General Hospital, Taipei 106, Taiwan; (Y.-L.L.); (Y.-L.H.); (C.-M.S.); (Y.-C.C.)
- Department of Pediatrics, National Taiwan University Children’s Hospital, Taipei 100, Taiwan
- Department of Pediatrics, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Correspondence: ; Tel.: +886-2-2708-2121 (ext. 6565); Fax: +886-2-6636-5967
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Mid-regional pro-adrenomedullin for diagnosing evolution after cardiac surgery in newborns: the PRONEW study. Eur J Pediatr 2022; 181:1017-1028. [PMID: 34686907 DOI: 10.1007/s00431-021-04278-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/13/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
Newborns are the most vulnerable patients after cardiac surgery. Although mortality risk scores before surgery may help predict the risk of poor outcome, new tools are required, and biomarkers could add objective data to these tools. The aim of this study was to assess the ability of mid-regional pro-adrenomedullin (pro-ADM) and pro-atrial natriuretic peptide (pro-ANP) to predict poor outcome after cardiac surgery. This is a pilot diagnostic accuracy study that includes newborns and infants under 2 months admitted to an intensive care unit after cardiac surgery. Pro-ADM and pro-ANP were determined immediately upon admission. Poor outcome was defined as mortality, cardiac arrest, requiring extracorporeal support, requiring renal replacement therapy, or neurological injury. Forty-four patients were included. Twenty-six (59%) had a STAT category of ≥ 4. Ten patients (22.7%) presented a poor outcome, four of whom (9.1%) died. Pro-ADM was higher in patients with poor outcome (p = 0.024) and death (p = 0.012). Pro-ADM showed the best area under curve (AUC) for predicting poor outcome (0.735) and mortality alone (0.869). A pro-ADM of 2 nmol/L had a Sn of 75% and a Sp of 85% for predicting mortality. Pro-ADM > 2 nmol/L was independently associated with poor outcome (OR 5.8) and mortality (OR 14.1). Although higher pro-ANP values were associated with poor outcomes, no cut-off point were found. The combination of STAT ≥ 4 and the biomarkers did not enhance predictive power for poor outcome or mortality.Conclusion: Pro-ADM and pro-ANP determined immediately after surgery could be helpful for stratifying risk of poor outcome and mortality in newborns. What is Known: • Some congenital heart diseases must be corrected/palliated during the first days of life. A useful tool to predict the risk of severe complications has not been proposed. • Most unstable newborns would have higher values of biomarkers such as pro-ADM and pro-ANP related to shock and compensatory actions. What is New: • Pro-ADM and pro-ANP seem to be good biomarkers to predict poor outcome after cardiac surgery. A pro-ADM < 2 nmol/L would imply a low likelihood of a poor outcome. • Deepening the analysis of biomarkers can help in making decisions to prevent/treat complications.
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Müller N, Bayer E, Bernhardt C, Breuer J, Freudenthal NJ. Performance of urinary NT-proBNP in ambulatory settings. Clin Chim Acta 2022; 529:4-9. [DOI: 10.1016/j.cca.2022.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 01/31/2022] [Accepted: 01/31/2022] [Indexed: 11/03/2022]
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Matsubara D, Chang J, Kauffman HL, Wang Y, Nadaraj S, Patel C, Paridon SM, Fogel MA, Quartermain MD, Banerjee A. Longitudinal Assessment of Cardiac Outcomes of Multisystem Inflammatory Syndrome in Children Associated With COVID-19 Infections. J Am Heart Assoc 2022; 11:e023251. [PMID: 35043684 PMCID: PMC9238494 DOI: 10.1161/jaha.121.023251] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background In multisystem inflammatory syndrome in children, there is paucity of longitudinal data on cardiac outcomes. We analyzed cardiac outcomes 3 to 4 months after initial presentation using echocardiography and cardiac magnetic resonance imaging. Methods and Results We included 60 controls and 60 cases of multisystem inflammatory syndrome in children. Conventional echocardiograms and deformation parameters were analyzed at 4 time points: (1) acute phase (n=60), (2) subacute phase (n=50; median, 3 days after initial echocardiography), (3) 1‐month follow‐up (n=39; median, 22 days), and (4) 3‐ to 4‐month follow‐up (n=25; median, 91 days). Fourteen consecutive cardiac magnetic resonance imaging studies were reviewed for myocardial edema or fibrosis during subacute (n=5) and follow‐up (n=9) stages. In acute phase, myocardial injury was defined as troponin‐I level ≥0.09 ng/mL (>3 times normal) or brain‐type natriuretic peptide >800 pg/mL. All deformation parameters, including left ventricular global longitudinal strain, peak left atrial strain, longitudinal early diastolic strain rate, and right ventricular free wall strain, recovered quickly within the first week, followed by continued improvement and complete normalization by 3 months. Median time to normalization of both global longitudinal strain and left atrial strain was 6 days (95% CI, 3–9 days). Myocardial injury at presentation (70% of multisystem inflammatory syndrome in children cases) did not affect short‐term outcomes. Four patients (7%) had small coronary aneurysms at presentation, all of which resolved. Only 1 of 9 patients had residual edema but no fibrosis by cardiac magnetic resonance imaging. Conclusions Our short‐term study suggests that functional recovery and coronary outcomes are good in multisystem inflammatory syndrome in children. Use of sensitive deformation parameters provides further reassurance that there is no persistent subclinical dysfunction after 3 months.
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Affiliation(s)
- Daisuke Matsubara
- Division of Cardiology Department of Pediatrics The Children's Hospital of Philadelphia PA
| | - Joyce Chang
- Division of Rheumatology Department of Pediatrics Children's Hospital of Philadelphia PA
| | - Hunter L Kauffman
- Division of Cardiology Department of Pediatrics The Children's Hospital of Philadelphia PA
| | - Yan Wang
- Division of Cardiology Department of Pediatrics The Children's Hospital of Philadelphia PA
| | - Sumekala Nadaraj
- Division of Cardiology Department of Pediatrics The Children's Hospital of Philadelphia PA
| | - Chandni Patel
- Division of Cardiology Department of Pediatrics The Children's Hospital of Philadelphia PA
| | - Stephen M Paridon
- Division of Cardiology Department of Pediatrics The Children's Hospital of Philadelphia PA
| | - Mark A Fogel
- Division of Cardiology Department of Pediatrics The Children's Hospital of Philadelphia PA
| | - Michael D Quartermain
- Division of Cardiology Department of Pediatrics The Children's Hospital of Philadelphia PA
| | - Anirban Banerjee
- Division of Cardiology Department of Pediatrics The Children's Hospital of Philadelphia PA
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Age-Dependent Reference Values for hs-Troponin T and NT-proBNP and Determining Factors in a Cohort of Healthy Children (The LIFE Child Study). Pediatr Cardiol 2022; 43:1071-1083. [PMID: 35277733 PMCID: PMC8916935 DOI: 10.1007/s00246-022-02827-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/11/2022] [Indexed: 01/03/2023]
Abstract
This study aimed to provide reliable pediatric reference values for N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitive Troponin T (hsTnT) obtained from a population of well children and investigate for associations with sex, pubertal status, body mass index (BMI), and serum lipid levels. We analyzed hsTnT and NT-proBNP values obtained from 4826 samples provided by 2522 children aged 0.25-18 years participating in a prospective longitudinal population-based cohort study, "LIFE child" in Leipzig, Germany (Poulain et al., Eur J Epidemiol 32:145-158, 2017). NT-proBNP values decreased throughout childhood from values over 400 ng/L at 3 months to 138 ng/L in females and 65 ng/L in males by 18 years of age. Values dropped rapidly with advancing pubertal stage. We found a strong association between lower NT-proBNP values and higher BMI or elevated serum lipids, the latter effect being more pronounced in males. For hsTnT levels, approximately half of the measurements were below the detection limit. However, 76% of those aged 3 months and 21% of those aged 6 months had values exceeding the adult cut-off limit. Females had slightly higher levels in the first 2 years of life but this was reversed during puberty. In males, there was an upward trend from pubertal stage 2 onward. We identified a positive association between hsTnT and BMI but a negative association with low-density lipoprotein (LDL) cholesterol and triglyceride levels in boys but not in girls. Based on a large number of healthy children, we have established reliable reference values for NT-proBNP and hsTnT for use in everyday clinical practice. We have also identified important associations between certain metabolic and cardiac markers.Clinical Trial Registration ClinicalTrial.gov (NCT02550236).
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Xie H, Huo Y, Chen Q, Hou X. Application of B-Type Natriuretic Peptide in Neonatal Diseases. Front Pediatr 2021; 9:767173. [PMID: 34950618 PMCID: PMC8689063 DOI: 10.3389/fped.2021.767173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/09/2021] [Indexed: 12/12/2022] Open
Abstract
Numerous congenital or secondary diseases, including, heart disease, respiratory disease, sepsis and many others, can lead to neonatal death. B-type natriuretic peptide (BNP) is a peptide hormone secreted by ventricular cells following an increase in ventricular wall tension. BNP functions to promote vasodilation, diuresis, and sodium release to regulate blood pressure. BNP is a sensitive index reflecting ventricular function, which may aid the diagnosis and monitoring of various neonatal diseases. In neonates, there is currently no consensus on a reference BNP level, as the plasma BNP concentration of healthy newborns varies with age, peaks in the first week after birth, and then gradually decreased to a stable level. In disease states, the correlation between the plasma BNP concentration and the results of echocardiography is good, which is of great significance in the screening, monitoring, and prognosis evaluation of neonatal cardiovascular diseases, including congenital heart disease, patent ductus arteriosus, etcetera. It also facilitates the judgment of the efficacy of treatment and perioperative management. Moreover, the monitoring of plasma BNP concentration provides guidance for the diagnosis, evaluation, and treatment selection of certain neonatal respiratory diseases and neonatal sepsis. This review summarizes the normal BNP values and discusses the application value of BNP in relation to physiological and pathological aspects in neonates.
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Affiliation(s)
| | | | | | - Xinlin Hou
- Department of Neonatal Ward, Peking University First Hospital, Beijing, China
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12
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Kindel SJ. Pediatric Data for Pediatric Heart Failure: Stepping Out on Our Own. J Am Coll Cardiol 2021; 78:1901-1903. [PMID: 34736566 DOI: 10.1016/j.jacc.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Steven J Kindel
- Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA.
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13
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Palm J, Holdenrieder S, Hoffmann G, Hörer J, Shi R, Klawonn F, Ewert P. Predicting Major Adverse Cardiovascular Events in Children With Age-Adjusted NT-proBNP. J Am Coll Cardiol 2021; 78:1890-1900. [PMID: 34736565 DOI: 10.1016/j.jacc.2021.08.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND N-terminal pro-B-type natriuretic peptide (NT-proBNP) is frequently used as a valuable prognostic biomarker in cardiac diseases. In children, however, it has not been established because of its strong age dependency. To overcome this obstacle, we recently introduced the zlog value of N-terminal pro-B-type natriuretic peptide (zlog-proBNP) as an age-adjusted reference. OBJECTIVES This study evaluates the prognostic power of zlog-proBNP for the occurrence of major adverse cardiovascular events (MACE) throughout childhood in patients with congenital heart diseases (CHD). METHODS A total of 910 children with CHD (median age 5 months; range 0.0-18.0 years) were included. MACE was defined as death, resuscitation, mechanical circulatory support, or hospitalization caused by cardiac decompensation. Because the physiological NT-proBNP concentration decreases significantly during childhood, zlog values were applied for an age-independent evaluation. RESULTS MACE occurred in 138 children during a median follow-up of 6 months (range 1 day to 7.6 years). High zlog-proBNP values (>+3.0) were most strongly associated with adverse events (n = 93; adjusted HR: 21.1; 95% CI: 2.9-154.2; P < 0.001). Among all evaluated indicators, zlog-proBNP was the best predictor for MACE (adjusted HR: 1.52; 95% CI: 1.31-1.76; P < 0.001) along with age and predictively superior to absolute NT-proBNP values. A cutoff value of +1.96 (age-independent upper limit of the physiological NT-proBNP concentration) achieved a negative predictive value of >96%. CONCLUSIONS Zlog-proBNP overcomes the strong age dependency of NT-proBNP and is a powerful prognostic marker for age-independent exclusion and prediction of MACE in children with CHD. We therefore expect zlog-proBNP to play a pivotal role in the future management of children with heart diseases.
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Affiliation(s)
- Jonas Palm
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center of the Technical University Munich, Munich, Germany.
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, German Heart Center of the Technical University Munich, Munich, Germany
| | - Georg Hoffmann
- Institute of Laboratory Medicine, German Heart Center of the Technical University Munich, Munich, Germany
| | - Jürgen Hörer
- Department for Congenital and Pediatric Heart Surgery, German Heart Center of the Technical University Munich, Munich, Germany; Division for Congenital and Pediatric Heart Surgery, University Hospital Großhadern, Ludwig-Maximilians University, Munich, Germany
| | - Ruibing Shi
- Biostatistics, Helmholtz Center for Infection Research, Braunschweig, Germany
| | - Frank Klawonn
- Biostatistics, Helmholtz Center for Infection Research, Braunschweig, Germany; Institute for Information Engineering, Ostfalia University of Applied Sciences, Wolfenbuttel, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center of the Technical University Munich, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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14
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Nyawo TA, Dludla PV, Mazibuko-Mbeje SE, Mthembu SXH, Nyambuya TM, Nkambule BB, Gijsen HSV, Strijdom H, Pheiffer C. A systematic review exploring the significance of measuring epicardial fat thickness in correlation to B-type natriuretic peptide levels as prognostic and diagnostic markers in patients with or at risk of heart failure. Heart Fail Rev 2021; 27:665-675. [PMID: 34671870 PMCID: PMC8898254 DOI: 10.1007/s10741-021-10160-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 01/13/2023]
Abstract
Emerging evidence suggests that epicardial fat thickness (EFT) may be a critical feature to understand cardiac health and determine the risk of heart failure. The current review critically assesses and discusses evidence on the efficiency of measuring EFT, in comparison to the well-known markers B-type natriuretic peptide (BNP) and its N-terminal fragment pro-B-type natriuretic peptide (NT-proBNP), as a prognostic and diagnostic approach in individuals with or at risk of heart failure. A systematic approach was undertaken to search major databases, PubMed, Scopus, Google Scholar and the Cochrane library to identify studies that quantified EFT and serum BNP/NT-proBNP levels in individuals with or at risk of heart failure. Twelve studies met the inclusion criteria and a total of 1983 participants were included in this systematic review. Evidence shows a clear association between increased EFT and elevated BNP/NT-proBNP levels in individuals with metabolic disease and suggests that both methods can be used for heart failure diagnosis and prognosis. However, due to the broad spectrum of challenges linked with measuring EFT, BNP/Pro-BNP is the predominant method used for heart failure diagnosis and prognosis in clinical practice. Nonetheless, measuring EFT provides a powerful and reproducible diagnostic tool for risk stratification and heart failure diagnosis and prognosis. Importantly, measuring EFT proves valuable to validate BNP/NT-proBNP levels to predict heart failure, especially due to its non-invasive nature.
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Affiliation(s)
- Thembeka A Nyawo
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, 7505, South Africa.,Centre for Cardiometabolic Research in Africa (CARMA), Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, 7505, Tygerberg, South Africa
| | - Phiwayinkosi V Dludla
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, 7505, South Africa
| | - Sithandiwe E Mazibuko-Mbeje
- Department of Biochemistry, Faculty of Natural and Agricultural Sciences, North West University, Mafikeng Campus, Mmabatho, 2735, South Africa
| | - Sinenhlanhla X H Mthembu
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, 7505, South Africa.,Department of Biochemistry, Faculty of Natural and Agricultural Sciences, North West University, Mafikeng Campus, Mmabatho, 2735, South Africa
| | - Tawanda M Nyambuya
- Department of Health Sciences, Faculty of Health and Applied Sciences, Namibia University of Science and Technology, Windhoek, 9000, Namibia
| | - Bongani B Nkambule
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, 4000, South Africa
| | - Hanél Sadie-Van Gijsen
- Centre for Cardiometabolic Research in Africa (CARMA), Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, 7505, Tygerberg, South Africa
| | - Hans Strijdom
- Centre for Cardiometabolic Research in Africa (CARMA), Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, 7505, Tygerberg, South Africa
| | - Carmen Pheiffer
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, 7505, South Africa. .,Centre for Cardiometabolic Research in Africa (CARMA), Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, 7505, Tygerberg, South Africa. .,Department of Obstetrics and Gynaecology, University of Pretoria, Private Bag X169, Pretoria, 0001, South Africa.
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15
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Temporal changes and control variables of growth differentiation factor 15 levels during the first week of life in hospitalised newborn infants. Mitochondrion 2021; 61:25-30. [PMID: 34508892 DOI: 10.1016/j.mito.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/13/2021] [Accepted: 09/07/2021] [Indexed: 11/20/2022]
Abstract
Serum growth differentiation factor 15 (GDF15) is a useful biomarker of mitochondrial diseases; its utility in newborns remains unknown. To investigate the temporal change in GDF15 within the first week of life, and to identify its potential control variables, blood samples were obtained from 18 newborns. The GDF15 levels declined to approximately 35% of the cord blood levels within the first week of life and were negatively correlated with postnatal age and Z-score of birth weight but were positively correlated with N-terminal pro-brain natriuretic peptide and lactate levels. GDF15 levels may reflect the progress of postnatal transition to aerobic metabolism.
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16
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Clerico A, Aimo A, Cantinotti M. Cardiac biomarkers for outcome prediction in infant bronchiolitis: Too soon to discard troponin? Clin Chim Acta 2021; 518:170-172. [PMID: 33839092 DOI: 10.1016/j.cca.2021.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Acute bronchiolitis, usually caused by the respiratory syncytial virus, is the most common cause of severe respiratory distress in infants. The clinical relevance of cardiac biomarkers for diagnosis and prognosis of bronchiolitis in infants is still controversial. AIM This Editorial discuss the results of a recent on the clinical relevance of cardiac specific biomarkers, NT-proBNP and cardiac troponin I (cTnI) in 40 infants with bronchiolitis, 37% requiring admission in the ICU. RESULTS NT-proBNP levels were significantly associated with prolonged hospitalization and duration of oxygen therapy, while cTnI levels, measured with high-sensitivity (hs) methods, did not. Furthermore NT-proBNP was significantly correlated with left and right ventricular functional echocardiographic parameters, while hs-cTnI was not associated with any echocardiographic parameter. DISCUSSION Recent results confirm that NT-proBNP assay has a crucial role in the diagnosis, prognosis and follow-up of patients with cardiac disease not only in adult, but even in pediatric age). On the other hand, the clinical usefulness of assay of hs-cTnI and hs-cTnT in pediatric cardiology, at present time, may be greatly limited by the lack of reliable reference intervals. CONCLUSIONS Further well-designed multi-center studies are needed to more accurately evaluate the clinical relevance of cardio-specific biomarkers, and in particular of hs-cTnI and hs-cTnT assay, on prognosis of infants with bronchiolitis.
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Affiliation(s)
- Aldo Clerico
- Fondazione CNR-Regione Toscana G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Alberto Aimo
- Fondazione CNR-Regione Toscana G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy
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17
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Salem SS, Saleh NY, Soliman SE, Abo-Haded HM. On-admission plasma levels of BNP, MR-proADM, and cTnI in pediatric heart failure: contributions to diagnosis, prognosis, and outcome. Ir J Med Sci 2021; 191:263-270. [PMID: 33564973 DOI: 10.1007/s11845-021-02533-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study is to evaluate the use of on-admission plasma levels of BNP, MR-proADM, and cTnI in diagnosing the clinical severity and progression of heart failure (HF) in children with CHD. Also, to correlate the levels of these biomarkers with the HF outcome (survival versus in-hospital mortality). RESULTS A prospective cohort study conducted in period from January 2017 to March 2018. All children presenting with HF had a Ross score assessment, echocardiography, and on-admission plasma level assay of BNP, MR-proADM, and cTnI. Patients were followed clinically throughout their hospital stay. The discriminatory power of on-admission measurement of each biomarker was determined using the receiver-operating characteristic (ROC). The results showed a significantly high on-admission plasma level of the 3 biomarkers among CHD cohort children than healthy controls (p < 0.001). Linear correlation was noted between the 3 biomarkers with Ross score, ejection fraction, and duration of hospital stay. Furthermore, significant association between on-admission level of the 3 biomarkers (BNP, MR-proADM, and cTnI) with patient's in-hospital mortality (p = 0.0003, Beta coefficient = 0.842; p = 0.0495, Beta coefficient = 0.183; and p < 0.001, Beta coefficient = 0.635, respectively), with on-admission BNP (cut of point 507.13) predicting in-hospital mortality, with 95.5% sensitivity, 88% specificity. CONCLUSIONS There is a high diagnostic value of measuring the on-admission levels of BNP, MR-proADM, and cTnI regarding the clinical severity and disease progression in the setting of pediatric heart failure, but the BNP level was more superior in prediction of the patients' outcome.
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Affiliation(s)
- Sherif S Salem
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Nagwan Y Saleh
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Shimaa E Soliman
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Hany M Abo-Haded
- Pediatric Cardiology Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
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18
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Yin X, Xin M, Ding S, Gao F, Wu F, Wang J, Chen J, Jiang L, Wu X, Wang X, Liu J, Zhang J, He S. Predictive role of perioperative neutrophil to lymphocyte ratio in pediatric congenital heart disease associated with pulmonary arterial hypertension. BMC Surg 2021; 21:3. [PMID: 33397333 PMCID: PMC7780205 DOI: 10.1186/s12893-020-01009-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/13/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We aimed to explore the relationship between the neutrophil to lymphocyte ratio (NLR) and the early clinical outcomes in children with congenital heart disease (CHD) associated with pulmonary arterial hypertension (PAH) after cardiac surgery. METHODS A retrospective observational study involving 190 children from January 2013 to August 2019 was conducted. Perioperative clinical and biochemical data were collected. RESULTS We found that pre-operative NLR was significantly correlated with AST, STB, CR and UA (P < 0.05), while post-operative NLR was significantly correlated with ALT, AST, BUN (P < 0.05). Increased post-operative neutrophil count and NLR as well as decreased lymphocyte count could be observed after cardiac surgery (P < 0.05). Level of pre-operative NLR was significantly correlated with mechanical ventilation time, ICU stay time and total length of stay (P < 0.05), while level of post-operative NLR was only significantly correlated to the first two (P < 0.05). By using ROC curve analysis, relevant areas under the curve for predicting prolonged mechanical ventilation time beyond 24 h, 48 h and 72 h by NLR were statistically significant (P < 0.05). CONCLUSION For patients with CHD-PAH, NLR was closely related to early post-operative complications and clinical outcomes, and could act as a novel marker to predict the occurrence of prolonged mechanical ventilation.
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Affiliation(s)
- Xiaoqiang Yin
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Mei Xin
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Sheng Ding
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Feng Gao
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Fan Wu
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Jian Wang
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Jie Chen
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Li Jiang
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Xiaochen Wu
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Xianying Wang
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jingzhen Liu
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Jinbao Zhang
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China.
- North Sichuan Medical College, Nanchong, Sichuan, China.
| | - Siyi He
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China.
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19
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Song M, Lei M, Luo C, Shi Z, Cheng X, Ding W, Cao W, Zhang J, Ge J, Wang M, Xia P, Mao F, Wang L, Zhang Q. Development of a Nomogram for Moderate-to-Severe Bronchopulmonary Dysplasia or Death: Role of N-Terminal Pro-brain Natriuretic Peptide as a Biomarker. Front Pediatr 2021; 9:727362. [PMID: 34497786 PMCID: PMC8419419 DOI: 10.3389/fped.2021.727362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study aimed to explore the clinical value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in predicting moderate-to-severe bronchopulmonary dysplasia (BPD)/death, and to establish an effective clinical predictive nomogram. Methods: We retrospectively analyzed very low birth weight infants (VLBWs) with gestational age ≤ 32 weeks. The NT-proBNP values were determined on the 1st, 3rd, 7th, 14th, 21st, and 28th days after birth. The correlation between NT-proBNP level and moderate-to-severe BPD/death was evaluated. Receiver operating characteristic (ROC) curve analysis was used to evaluate the prediction ability. Then, we used multivariable logistic regression to build the prediction model and nomogram, and calibration of the model was assessed by calibration curve. Results: In total, 556 VLBWs were involved, among whom 229 developed BPD (mild: n = 109; moderate: n = 68; severe: n = 52) and 18 died. The NT-proBNP level in the moderate-to-severe BPD/death group was significantly higher than that in the no-to-mild BPD group from the 3rd to 28th day (P < 0.001). When the natural logarithm of the serum NT-ProBNP level increased by 1 unit at day 7 (±2 days) of life, the risk of moderate and severe BPD/death was the highest (OR = 3.753; 95% CI: 2.984~4.720), and ROC analysis identified an optimal cutoff point of 3360 ng/L (sensitivity: 80.0%; specificity: 86.2%; AUC: 0.861). After adjusting for confounding factors, the level of NT-proBNP at day 7 (±2 days) of life still had important predictive value for the development of moderate-to-severe BPD/death, significantly improving the predictive ability of the model. Conclusion: The level of NT-proBNP at day 7 (±2 days) of life can be used as an early promising biomarker for VLBWs to develop moderate-to-severe BPD/death. We constructed an early predictive nomogram to help clinicians identify high-risk populations.
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Affiliation(s)
- Min Song
- Neonatal Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengyuan Lei
- Health Care Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chenghan Luo
- Orthopeadics Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zanyang Shi
- Neonatal Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinru Cheng
- Neonatal Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenqian Ding
- Neonatal Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenjun Cao
- Neonatal Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingdi Zhang
- Neonatal Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jian Ge
- Neonatal Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengmeng Wang
- Neonatal Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peige Xia
- Neonatal Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fengxia Mao
- Neonatal Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Wang
- Neonatal Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qian Zhang
- Neonatal Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Abstract
Pediatric heart failure (PHF) affects 0.87 to 7.4 per 100,000 children. It has a 5-year mortality or heart transplant rate of 40%. Diagnosis often is delayed because initial symptoms are similar to common pediatric illnesses. Disease progression is tracked by symptoms, echocardiogram, and biomarkers. Treatment is extrapolated from mostly adult heart failure (HF) literature. Recent studies demonstrate differences between pediatric and adult HF pathophysiology. Increased collaboration among PHF programs is advancing the management of PHF. Unfortunately, there are patients who ultimately require heart transplantation, with increasing numbers supported by a ventricular assist device as a bridge to transplantation.
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Affiliation(s)
- Kae Watanabe
- Northwestern University, 225 East Chicago Avenue, Box 21, Chicago, IL 60611-2605, USA.
| | - Renata Shih
- University of Florida, 1600 Southwest Archer Road PO Box 100296, Gainesville, FL 32610, USA
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21
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Lam E, Higgins V, Zhang L, Chan MK, Bohn MK, Trajcevski K, Liu P, Adeli K, Nathan PC. Normative Values of High-Sensitivity Cardiac Troponin T and N-Terminal pro-B-Type Natriuretic Peptide in Children and Adolescents: A Study from the CALIPER Cohort. J Appl Lab Med 2020; 6:344-353. [PMID: 32995884 DOI: 10.1093/jalm/jfaa090] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/21/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Cardiac troponin (cTn) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are increasingly used clinically to evaluate and prognosticate acute myocardial infarction and heart failure, respectively. Pediatric reference intervals and cut-offs have not been established for Roche's Elecsys Troponin T hs (high sensitive) assay. Although pediatric reference intervals exist for NT-proBNP, cut-off values do not exist. In this study, we report reference intervals and 99th percentile cut-offs in a large, healthy Canadian pediatric population using the CALIPER cohort. METHODS Blood samples from 484 healthy children and adolescents between 0 and <19 years old were recruited from hospital outpatient clinics and community settings. Serum samples were analyzed using Roche's Cobas e411 and evaluated for high-sensitivity cTnT (hs-cTnT) and NT-proBNP concentrations. 95% reference intervals and 99th percentile cut-off values were established. RESULTS Three hs-cTnT age partitions were established (0 to <6 months, 6 months to <1 year, and 1 to <19 years) with highest concentrations observed in children under 1 year. Two NT-proBNP age partitions were established (0 to <1 year, and 1 to <19 years), also with higher concentrations in infants under 1 year of age. For each of these age partitions, the 99th percentile cut-off, 95% reference interval, and proportion of detectable concentrations were determined. CONCLUSIONS This is the first study to examine hs-cTnT and NT-proBNP reference values together in a healthy pediatric cohort without other clinical indications. We present 99th percentile cut-offs, which will allow clinicians to appropriately evaluate cardiovascular disease in children and adolescents.
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Affiliation(s)
- Emily Lam
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Victoria Higgins
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Liyong Zhang
- Cardiac Function Laboratory, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Man Khun Chan
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Mary Kathryn Bohn
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Karin Trajcevski
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Peter Liu
- Cardiac Function Laboratory, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Khosrow Adeli
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Paul C Nathan
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
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22
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Burdman I, Burckhardt BB. Prorenin and active renin levels in paediatrics: a bioanalytical review. Clin Chem Lab Med 2020; 59:275-285. [PMID: 32813674 DOI: 10.1515/cclm-2020-0857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/30/2020] [Indexed: 11/15/2022]
Abstract
As part of the extended renin-angiotensin-aldosterone system, active renin and its precursor prorenin have been an area of research interest for decades. Although several studies showed a correlation with disease, other studies found no significant association, e.g. attributed to limited sample size or pharmacological effects of antihypertensive drugs. Since the measurement of both proteins has typically been carried out in adult populations, the data in paediatrics is limited. This review aimed to collate the current data on plasma renin and prorenin levels in children and compare the levels of healthy vs. the diseased state. A literature search using Medline resulted in 213 publications of which 15 studies were classified as relevant. In the extant studies in the literature, an age-dependent decline of renin plasma concentration was observed in newborns compared to adolescents. For children with cardiovascular disease, five studies were identified that provide limited insight into the pathophysiological regulation of renin. In general, sample handling is still a crucial step, which might particularly affect measured active renin concentrations due to conformational changes of its precursor prorenin. A reliable assessment for prorenin levels in the maturating population is yet not possible due to the low number of available publications. Three different approaches to quantify prorenin were found and raise the question on the comparability of these methods. The review emphazised several weaknesses and highlights the need for an accurate procedure to determine levels of active renin as well as prorenin in its closed and open form.
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Affiliation(s)
- Ilja Burdman
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich-Heine-University, Dusseldorf, Germany
| | - Bjoern B Burckhardt
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich-Heine-University, Dusseldorf, Germany
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Pro-atrial natriuretic peptide and pro-adrenomedullin before cardiac surgery in children. Can we predict the future? PLoS One 2020; 15:e0236377. [PMID: 32702064 PMCID: PMC7377469 DOI: 10.1371/journal.pone.0236377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/02/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Pro-atrial natriuretic peptide (proANP) and pro-adrenomedullin (proADM) levels increase in acute heart failure and sepsis. After cardiac surgery, children may require increased support in the intensive care unit and may develop complications. The aim of this study was to evaluate the utility of proANP and proADM values, determined prior to cardiac surgery, for predicting the need for increased respiratory or inotropic support during the post-operative period. METHODS This was a prospective study in children. Biomarkers were analyzed before surgery using a single blood test. The primary endpoints were the need for greater respiratory and/or inotropic support during the post-operative period. Secondary endpoints were the relationship between these biomarkers and complications after surgery. RESULTS One hundred thirteen patients were included. ProANP and proADM were higher in children who required greater respiratory and inotropic support, especially proANP; for increased respiratory support, 578.9 vs. 106.6 pmol/L (p = 0.004), and for increased inotropic support, 1938 vs. 110.4 pmol/L (p = 0.002). ProANP had a greater AUC than proADM for predicting increased respiratory support after surgery: 0.791 vs. 0.724. A possible cut-off point for proANP could be ≥ 325 pmol/L (sensitivity = 66.7% and specificity = 88.8%). In the multivariate analysis, the logarithmic transformation of proANP was independently associated with the need for increased respiratory support (OR = 3.575). Patients who presented a poor outcome after cardiac surgery also had higher biomarker values (proADM, p = 0.013; proANP, p = 0.001). CONCLUSIONS Elevated proANP before cardiac surgery may identify which children will need more respiratory and inotropic support during the post-operative period.
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Left Ventricular Diastolic Dysfunction and Diastolic Heart Failure in Preterm Infants. Pediatr Cardiol 2019; 40:1709-1715. [PMID: 31598743 DOI: 10.1007/s00246-019-02208-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 08/16/2019] [Indexed: 01/06/2023]
Abstract
Diastolic dysfunction is primarily an echocardiographic diagnosis. Its clinical counterpart is diastolic heart failure, where the heart has difficulty to fill at normal pressure and the patient develops signs of pulmonary edema. Although diastolic dysfunction is common in adults, limited information is available in preterm infants. The aim of this study is to explore left ventricular diastolic dysfunction and diastolic heart failure in preterm infants and describe clinical manifestations in this population. This is a retrospective observational study in preterm infants < 30 weeks' gestation who received an echocardiography in the first 4 weeks after birth. Diastolic dysfunction was graded using a population-specific adapted version of the adult recommendations for the evaluation of left ventricular diastolic function by echocardiography. Left ventricular diastolic dysfunction was absent, indeterminate, and definite in 82%, 14%, and 4% of the 168 echocardiograms analyzed, and is associated with increased respiratory signs and respiratory deterioration at 48 h before echocardiogram. In seven infants, diastolic heart failure was diagnosed with both ultrasound and clinical signs. The cumulative risk of diastolic dysfunction increased with the increasing postnatal age and a patent ductus arteriosus. Evidence of left ventricular diastolic dysfunction on echocardiography is relatively common in preterm infants, while the left ventricular diastolic heart failure is less frequent. Prolonged exposure to volume load was the most common cause.
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Mueller C, McDonald K, de Boer RA, Maisel A, Cleland JG, Kozhuharov N, Coats AJ, Metra M, Mebazaa A, Ruschitzka F, Lainscak M, Filippatos G, Seferovic PM, Meijers WC, Bayes‐Genis A, Mueller T, Richards M, Januzzi JL. Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations. Eur J Heart Fail 2019; 21:715-731. [DOI: 10.1002/ejhf.1494] [Citation(s) in RCA: 250] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/04/2019] [Accepted: 04/23/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB)University Hospital Basel, University of Basel Basel Switzerland
| | - Kenneth McDonald
- Department of CardiologySt. Vincent's University Hospital Dublin Ireland
| | - Rudolf A. de Boer
- University of Groningen, University Medical CenterGroningen, Department of Cardiology The Netherlands
| | | | - John G.F. Cleland
- Robertson Institute of Biostatistics and Clinical Trials UnitUniversity of Glasgow Glasgow UK
| | - Nikola Kozhuharov
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB)University Hospital Basel, University of Basel Basel Switzerland
| | - Andrew J.S. Coats
- University of Warwick Coventry UK
- Monash University Melbourne Australia
- Pharmacology, Centre of Clinical and Experimental Medicine, San Raffaele Pisana Scientific Institute Rome Italy
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of Brescia Brescia Italy
| | - Alexandre Mebazaa
- Université de Paris, APHP Département d'Anethésie‐Réanimation Hôpitaux Universitaires Saint Louis Lariboisière Paris France
| | - Frank Ruschitzka
- Department of Cardiology, University Heart CentreUniversity Hospital Zurich Zurich Switzerland
| | - Mitja Lainscak
- Department of Internal MedicineGeneral Hospital Murska Sobota Murska Sobota Slovenia
- Faculty of MedicineUniversity of Ljubljana Slovenia
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital AttikonUniversity of Athens Greece
- University of CyprusMedical School Nicosia Cyprus
| | | | - Wouter C. Meijers
- University of Groningen, University Medical CenterGroningen, Department of Cardiology The Netherlands
| | - Antoni Bayes‐Genis
- Heart InstituteHospital Universitari Germans Trias i Pujol, CIBERCV Barcelona Spain
- Department of MedicineAutonomous University of Barcelona Barcelona Spain
| | - Thomas Mueller
- Department of Clinical PathologyHospital of Bolzano Bolzano Italy
| | - Mark Richards
- Christchurch Heart InstituteUinversity of Otago New Zealand
- Cardiovascular Research InstituteNational University of Singapore Singapore
| | - James L. Januzzi
- Cardiology Division of the Department of MedicineMassachusetts General Hospital, Harvard Medical School Boston MA USA
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Nasi-Er BG, Lou X, Zhang Y, Sun H, Zhou X, Li Y, Zhou Q, Zhang J, Tang B, Lu Y. Renal Sympathetic Denervation Improves Outcomes in a Canine Myocardial Infarction Model. Med Sci Monit 2019; 25:3887-3893. [PMID: 31127792 PMCID: PMC6556070 DOI: 10.12659/msm.914384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Myocardial infarction (MI) is the main cause of heart failure (HF), and sympathetic nerve activity is associated with prognosis chronic heart failure. Renal sympathetic denervation (RDN) is noted for its powerful effect on the inhibition of sympathetic nerve activity. This study investigated the effect of RDN on heart failure in dogs after myocardial infarction. Material/Methods The experimental animals were randomized into 2 groups: the MI group (n=12) and the sham operation group (n=6). In the MI group we established an MI model by permanently ligating the left anterior descending branch. After 4 weeks, the MI dogs were randomly divided into 2 groups: the MI+RDN group (MI+renal sympathetic denervation, n=6) and the simple MI group (n=6). Animals in the MI+RDN group underwent both surgical and chemical renal denervation. Results Compared with sham operation group, left ventricular fraction shortening (LVFS) and left ventricular ejection fraction (LVEF) were significantly reduced in the simple MI group, while the reduction was partly reversed in the MI+RDN group. RDN reduced sympathetic nerve activity and release of B-type natriuretic peptide (BNP) and Angiotensin II (AngII) in the MI+ RDN group but not in the simple MI group. Conclusions Canine renal sympathetic denervation prevents myocardial malignant remodeling by lowering the activity of the systemic sympathetic nerve and inhibiting renin-angiotensin-aldosterone system (RASS) activation, providing a new target and method for the treatment of heart failure.
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Affiliation(s)
- Buajieer-Guli Nasi-Er
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Xue Lou
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Yinling Zhang
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Huaxin Sun
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Xianhui Zhou
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Yaodong Li
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Qina Zhou
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Jianghua Zhang
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Baopeng Tang
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Yanmei Lu
- Xinjiang Key Laboratory of Medical Animal Model Research, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
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Missed Diagnosis of New-Onset Systolic Heart Failure at First Presentation in Children with No Known Heart Disease. J Pediatr 2019; 208:258-264.e3. [PMID: 30679055 DOI: 10.1016/j.jpeds.2018.12.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine frequency of missed heart failure diagnosis at first presentation among children with no known heart disease admitted with new-onset heart failure. STUDY DESIGN Using a retrospective design, we reviewed electronic medical records of all patients aged <21 years with no known heart disease, hospitalized with new-onset heart failure during 2003-2015 at a tertiary-quaternary care institution. We assessed records for missed diagnosis of heart failure (primary outcome), associated process breakdowns, and clinical outcomes using a structured data collection instrument. RESULTS Of 191 patients meeting inclusion criteria, 49% (94/191) were missed on first presentation. Most common incorrect diagnostic labels given to "missed" patients were bacterial infection (29%; 27/94), followed by viral illness (22%; 21/94) and gastroenteritis/hepatitis (21%; 20/94). On multivariable analysis, presentation to primary care provider (PCP), longer duration of symptoms (median 7 days), more than 2 symptoms of heart failure, and nausea/emesis were associated with missed diagnosis. On examining process breakdowns, 49% had errors in history-taking and 50% had no documentation of differential diagnoses. There was no difference in hospital mortality, length of stay, or mechanical circulatory support in missed vs not-missed cohorts. Unnecessary noninvasive and invasive tests were performed in 18% and 4% of patients, respectively. CONCLUSIONS Nearly one-half of children with no known heart disease hospitalized with systolic heart failure were missed at first presentation and underwent significant nonrelevant treatment and testing. Initial presentation to the PCP, longer duration of symptoms before presentation, and nausea/emesis were associated with missed diagnosis.
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Change in N-terminal pro B-type natriuretic peptide levels and clinical outcomes in children undergoing congenital heart surgery. Int J Cardiol 2019; 283:96-100. [DOI: 10.1016/j.ijcard.2019.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/31/2019] [Accepted: 02/13/2019] [Indexed: 11/20/2022]
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Rodriguez-Gonzalez M, Perez-Reviriego AA, Castellano-Martinez A, Cascales-Poyatos HM. N-terminal probrain natriuretic peptide as biomarker for diagnosis of Kawasaki disease. Biomark Med 2019; 13:307-323. [PMID: 30900472 DOI: 10.2217/bmm-2018-0324] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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You H, Jiang W, Jiao M, Wang X, Jia L, You S, Li Y, Wen H, Jiang H, Yuan H, Huang J, Qiao B, Yang Y, Jin M, Wang Y, Du J. Association of Soluble ST2 Serum Levels With Outcomes in Pediatric Dilated Cardiomyopathy. Can J Cardiol 2019; 35:727-735. [PMID: 31151708 DOI: 10.1016/j.cjca.2019.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/18/2019] [Accepted: 02/18/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Prognosis in patients with pediatric dilated cardiomyopathy (PDCM) is urgently required to identify high-risk patients. Elevated soluble ST2 (sST2) is associated with prognosis in adult patients with heart failure. This study aimed to assess the prognostic value of sST2 in PDCM. METHODS Ninety-four patients with PDCM were enrolled after admission from 2 centres in China and followed up for adverse events (death, cardiac transplantation, and heart-failure-related rehospitalization). B-type natriuretic peptide (BNP) and sST2 levels were measured. RESULTS Over a median of 678 (interquartile range [IQR]: 533-785) days, 28 (29.8%) adverse events occurred. Patients in the highest tertile of sST2 levels had increased risk of short-term (< 6 months) (adjusted hazard ratio [HR]: 8.36, 95% confidence interval [CI], 1.02-73.52; P < 0.05) and long-term adverse events (2 years) (adjusted HR: 4.23; 95% CI, 1.32-13.60; P < 0.01) than those in lower tertiles. The C-statistic was increased with addition of sST2 to BNP from 0.697 (95% CI, 0.541-0.852) to 0.812 (95% CI, 0.697-0.939) for short-term and from 0.712 (95% CI, 0.604-0.819) to 0.798 (95% CI, 0.697-0.899) for prediction of long-term adverse events. An intermediate-risk subgroup was identified, and 24% had adverse events. When serial measurements were taken in a nested case-control subgroup, sST2 levels were constantly high in patients with late adverse events (> 6 months) but gradually decreased in nonadverse-event controls compared with 3-month and 6-month baseline levels. CONCLUSIONS In patients with PDCM, serum sST2 levels are associated with adverse events and have robust prognostic value. Serial measurements of sST2 could help in managing patients for monitoring outcomes of treatment.
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Affiliation(s)
- Hongzhao You
- Beijing Anzhen Hospital, Capital Medical University; Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Centre for Cardiovascular Disorders; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China; State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital and National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenxi Jiang
- Beijing Anzhen Hospital, Capital Medical University; Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Centre for Cardiovascular Disorders; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Meng Jiao
- Beijing Anzhen Hospital, Capital Medical University; Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Centre for Cardiovascular Disorders; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China; Department of Pediatric Heart Centre, Beijing Anzhen Hospital, Capital Medical University; Beijing Pediatric Heart Centre, Beijing, China
| | - Xue Wang
- Beijing Anzhen Hospital, Capital Medical University; Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Centre for Cardiovascular Disorders; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Lixin Jia
- Beijing Anzhen Hospital, Capital Medical University; Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Centre for Cardiovascular Disorders; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Shijie You
- State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital and National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yulin Li
- Beijing Anzhen Hospital, Capital Medical University; Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Centre for Cardiovascular Disorders; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Haichu Wen
- Beijing Anzhen Hospital, Capital Medical University; Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Centre for Cardiovascular Disorders; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Hongfeng Jiang
- Beijing Anzhen Hospital, Capital Medical University; Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Centre for Cardiovascular Disorders; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Hui Yuan
- Department of Clinical Laboratory, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jie Huang
- State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital and National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bokang Qiao
- Beijing Anzhen Hospital, Capital Medical University; Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Centre for Cardiovascular Disorders; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Ya Yang
- Beijing Anzhen Hospital, Capital Medical University; Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Centre for Cardiovascular Disorders; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Mei Jin
- Beijing Anzhen Hospital, Capital Medical University; Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Centre for Cardiovascular Disorders; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China; Department of Pediatric Heart Centre, Beijing Anzhen Hospital, Capital Medical University; Beijing Pediatric Heart Centre, Beijing, China.
| | - Yuan Wang
- Beijing Anzhen Hospital, Capital Medical University; Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Centre for Cardiovascular Disorders; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
| | - Jie Du
- Beijing Anzhen Hospital, Capital Medical University; Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Centre for Cardiovascular Disorders; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
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Sato M, Inai K, Shimizu M, Sugiyama H, Nakanishi T. Bioelectrical impedance analysis in the management of heart failure in adult patients with congenital heart disease. CONGENIT HEART DIS 2018; 14:167-175. [PMID: 30351489 DOI: 10.1111/chd.12683] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 09/01/2018] [Accepted: 09/12/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The recognition of fluid retention is critical in treating heart failure (HF). Bioelectrical impedance analysis (BIA) is a well-known noninvasive method; however, data on its role in managing patients with congenital heart disease (CHD) are limited. Here, we aimed to clarify the correlation between BIA and HF severity as well as the prognostic value of BIA in adult patients with CHD. DESIGN This prospective single-center study included 170 patients with CHD admitted between 2013 and 2015. We evaluated BIA parameters (intra- and extracellular water, protein, and mineral levels, edema index [EI, extracellular water-to-total body water ratio]), laboratory values, and HF-related admission prevalence. RESULTS Patients with New York Heart Association (NYHA) functional classes III-IV had a higher EI than those with NYHA classes I-II (mean ± SD, 0.398 ± 0.011 vs 0.384 ± 0.017, P < .001). EI was significantly correlated with brain natriuretic peptide level (r = 0.51, P < .001). During the mean follow-up period of 7.1 months, Kaplan-Meier analysis showed that a discharge EI > 0.386, the median value in the present study, was significantly associated with a future increased risk of HF-related admission (HR = 4.15, 95% CI = 1.70-11.58, P < .001). A body weight reduction during hospitalization was also related to EI reduction. CONCLUSIONS EI determined using BIA could be a useful marker for HF severity that could predict future HF-related admissions in adult patients with CHD.
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Affiliation(s)
- Masaki Sato
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kei Inai
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan.,Division of Adult Congenital Heart Disease Pathophysiology and Lifelong Care, Tokyo Women's Medical University, Tokyo, Japan
| | - Mikiko Shimizu
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Nakanishi
- Division of Adult Congenital Heart Disease Pathophysiology and Lifelong Care, Tokyo Women's Medical University, Tokyo, Japan
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Risk factors and outcomes of tracheostomy after prolonged mechanical ventilation in pediatric patients with heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Krichevskiy LA, Kozlov IA. Natriuretic Peptides in Cardiac Anesthesia and Intensive Care. J Cardiothorac Vasc Anesth 2018; 33:1407-1419. [PMID: 30228053 DOI: 10.1053/j.jvca.2018.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Indexed: 01/16/2023]
Abstract
Natriuretic peptides, predominantly B-type, are widely used in cardiology as prognostic and diagnostic biomarkers or, much less often, as a substantive treatment tool. They are hormones that are produced mainly in the myocardium in response to overload and ischemia, and their level quite accurately reflects the degree of myocardial dysfunction. Although their use in cardiac anesthesia and intensive care setting seems to be very beneficial for assessing the risk of acute disturbance of myocardial function or its laboratory monitoring, the actual significance of natriuretic peptides in this area is not yet recognized. This is due to the lack of clear diagnostic and prognostic values for these biomarkers supported by high-quality researches. On the basis of the available data, main advantages, existing difficulties, and most effective ways of using natriuretic peptides for determining the risk of heart surgery and assessing the severity of sepsis, pneumonia, and other critical conditions have been discussed in this review. In addition, the expediency of using natriuretic peptides as target parameters for goal-oriented therapy and as a substantive tool for treatment is considered.
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Affiliation(s)
- Lev A Krichevskiy
- Department of Anesthesiology and Intensive Care, City Clinical Hospital n.a. S.S.Yudin, Department of Health of Moscow, Moscow, Russia.
| | - Igor A Kozlov
- Department of Anaesthesiology, Moscow Regional Research Clinical Institute n.a. M.F. Vladimirskiy, Moscow, Russia
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Rodríguez-Blanco S, Oulego-Erroz I, Alonso-Quintela P, Terroba-Seara S, Jiménez-González A, Palau-Benavides M. N-terminal-probrain natriuretic peptide as a biomarker of moderate to severe bronchopulmonary dysplasia in preterm infants: A prospective observational study. Pediatr Pulmonol 2018; 53:1073-1081. [PMID: 29790673 DOI: 10.1002/ppul.24053] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/20/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVE N-terminal-probrain natriuretic peptide (NT-proBNP) is a marker of hemodynamically significant patent ductus arteriosus (HsPDA) in preterm infants. In this study, we assessed whether NT-proBNP levels could predict the risk of moderate to severe bronchopulmonary dysplasia (BPD) and/or death. METHODS This was an observational prospective study of preterm infants with GA ≤32 weeks. Infants who died within the first 48 h or who had major congenital malformations or incomplete information were excluded. NT-proBNP was determined at 48-96 h of life and at 5-10 days of life. The predictive capacity of NT-proBNP for the combined outcome of BPD and/or death was evaluated using receiver operator characteristic (ROC) curves and multivariate regression. RESULTS Of the 125 eligible patients, 110 completed the analysis. Twenty-eight developed BPD (n = 15) and/or died (n = 13). Infants who developed BPD and/or died had higher NT-proBNP levels at 48-96 h (26,848 ng/L, interquartile range [IQR] 7818-60,684 vs 3008 ng/L, IQR 1425-9876) and at 5-10 days (8849 ng/L, IQR 3796-19,526 vs 1427 ng/L, IQR 907-2889). The NT-proBNP levels at 5-10 days, but not at 48-96 h, were independently associated with BPD and/or death after adjustments for HsPDA and other confounders (OR = 3.36; 95%CI: 1.52-7.4, P = 0.006). For the prediction of this result, a cutoff of 3348 ng/L had a sensitivity and specificity of 82% and 83%, respectively (area under the curve [AUC] = 0.87; 95%CI: 0.79-0.95). CONCLUSION The NT-proBNP levels at 5-10 days of life may identify preterm infants with an HsPDA who are at high risk of BPD or death and may be useful for individualized preventive and therapeutic strategies.
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Affiliation(s)
- Silvia Rodríguez-Blanco
- Neonatal Intensive Care Unit, Department of Neonatology, Complejo Asistencial Universitario de León, León, Spain
| | - Ignacio Oulego-Erroz
- Pediatric Intensive Care Unit, Complejo Asistencial Universitario de León, León, Spain
| | - Paula Alonso-Quintela
- Neonatal Intensive Care Unit, Department of Neonatology, Complejo Asistencial Universitario de León, León, Spain
| | - Sandra Terroba-Seara
- Neonatal Intensive Care Unit, Department of Neonatology, Complejo Asistencial Universitario de León, León, Spain
| | - Aquilina Jiménez-González
- Neonatal Intensive Care Unit, Department of Neonatology, Complejo Asistencial Universitario de León, León, Spain
| | - Maite Palau-Benavides
- Neonatal Intensive Care Unit, Department of Neonatology, Complejo Asistencial Universitario de León, León, Spain
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Early NT-proBNP levels as a screening tool for the detection of hemodynamically significant patent ductus arteriosus during the first week of life in very low birth weight infants. J Perinatol 2018; 38:881-888. [PMID: 29785059 DOI: 10.1038/s41372-018-0123-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 02/22/2018] [Accepted: 03/26/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess whether early NT-ProBNP can identify the need for echocardiographic assessment of hemodynamically significant patent ductus arteriosus (HsPDA) in preterm infants. STUDY DESIGN Prospective observational study of infants with a gestational age ≤32 weeks. Echocardiographic assessment and NT-proBNP measurement were performed at 48-96 h. ROC curves were generated to assess optimal cutoffs to detect HsPDA and predict the need for treatment. RESULTS Eighty-five patients were included. HsPDA was present in 28 infants (37.6%), and 22 (25.8%) received treatment. The optimal NT-proBNP cutoff for the detection of HsPDA was 5099 pg/mL (sensitivity 94%, specificity 82%, area under the curve 0.941, P < 0.001). Only 1 child with NT-proBNP levels <5099 pg/mL was ultimately treated for PDA. NT-proBNP screening could have avoided 45 of 85 routine echocardiograms (53%). CONCLUSION NT-proBNP screening at 48-96 h of life may identify preterm infants at low risk for HsPDA, improving PDA management.
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Wu Y, Si F, Luo L, Yi Q. Serum levels of melatonin may contribute to the pathogenesis of heart failure in children with median age of 1 year. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Cassalett-Bustillo G. Falla cardíaca en pacientes pediátricos. Fisiopatología y manejo. Parte I. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Wu Y, Si F, Luo L, Yi Q. Serum levels of melatonin may contribute to the pathogenesis of heart failure in children with median age of 1 year. J Pediatr (Rio J) 2018; 94:446-452. [PMID: 29111293 DOI: 10.1016/j.jped.2017.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/13/2017] [Accepted: 06/14/2017] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Melatonin has a protective role in adults with cardiovascular disease, but the effects of melatonin in children with cardiac dysfunction are not well understood. This study was designed to explore the variations in melatonin, myeloperoxidase, and caspase-3 levels in children suffering from heart failure. METHODS Seventy-two pediatric patients with heart failure and twelve healthy children were enrolled in this study. A modified Ross scoring system was used to evaluate clinical cardiac function. Patients with a score of >2 points were included in the study and were divided into three groups according to severity of heart failure: mild (score: 3-6), moderate (score: 7-9), and severe (score: 10-12). Echocardiographic parameters, laboratory data, and serum levels of melatonin, myeloperoxidase, and caspase-3 were measured and analyzed in all patients. RESULTS Compared with patients with mild and moderate heart failure, patients in the severe heart failure group had significantly decreased left ventricular ejection fraction (p<0.001), and significantly increased serum melatonin levels (p=0.013) and myeloperoxidase levels (p<0.001). Serum melatonin levels were positively correlated with serum caspase-3 levels (p<0.001). The optimal cutoff values of serum melatonin levels for the diagnosis of severe heart failure and primary cardiomyopathy in pediatric patients with heart failure were 54.14pg/mL and 32.88pg/mL, respectively. CONCLUSIONS Serum melatonin and myeloperoxidase levels were increased in children with severe heart failure. It is likely that increasing melatonin levels may act as a compensatory mechanism in pediatric children with heart failure.
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Affiliation(s)
- Yao Wu
- Key Laboratory of Pediatrics in Chongqing, Chongqing, China; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China; Children's Hospital of Chongqing Medical University, Department of Cardiovascular Medicine, Chongqing, China
| | - Feifei Si
- Key Laboratory of Pediatrics in Chongqing, Chongqing, China; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China; Children's Hospital of Chongqing Medical University, Department of Cardiovascular Medicine, Chongqing, China
| | - Li Luo
- Key Laboratory of Pediatrics in Chongqing, Chongqing, China; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China; Children's Hospital of Chongqing Medical University, Department of Cardiovascular Medicine, Chongqing, China
| | - Qijian Yi
- Key Laboratory of Pediatrics in Chongqing, Chongqing, China; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China; Children's Hospital of Chongqing Medical University, Department of Cardiovascular Medicine, Chongqing, China.
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Abstract
Natriuretic peptides are structurally related, functionally diverse hormones. Circulating atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are delivered predominantly by the heart. Two C-type natriuretic peptides (CNPs) are paracrine messengers, notably in bone, brain, and vessels. Natriuretic peptides act by binding to the extracellular domains of three receptors, NPR-A, NPR-B, and NPR-C of which the first two are guanylate cyclases. NPR-C is coupled to inhibitory proteins. Atrial wall stress is the major regulator of ANP secretion; however, atrial pressure changes plasma ANP only modestly and transiently, and the relation between plasma ANP and atrial wall tension (or extracellular volume or sodium intake) is weak. Absence and overexpression of ANP-related genes are associated with modest blood pressure changes. ANP augments vascular permeability and reduces vascular contractility, renin and aldosterone secretion, sympathetic nerve activity, and renal tubular sodium transport. Within the physiological range of plasma ANP, the responses to step-up changes are unimpressive; in man, the systemic physiological effects include diminution of renin secretion, aldosterone secretion, and cardiac preload. For BNP, the available evidence does not show that cardiac release to the blood is related to sodium homeostasis or body fluid control. CNPs are not circulating hormones, but primarily paracrine messengers important to ossification, nervous system development, and endothelial function. Normally, natriuretic peptides are not powerful natriuretic/diuretic hormones; common conclusions are not consistently supported by hard data. ANP may provide fine-tuning of reno-cardiovascular relationships, but seems, together with BNP, primarily involved in the regulation of cardiac performance and remodeling. © 2017 American Physiological Society. Compr Physiol 8:1211-1249, 2018.
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Affiliation(s)
- Peter Bie
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
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Abstract
PURPOSE OF REVIEW Heart failure is a rare but morbid diagnosis in the pediatric patient presenting to the emergency department (ED). Familiarity of the ED physician with the presentation, work-up, and management of pediatric heart failure is essential as accurate diagnosis is reliant on a high degree of suspicion. RECENT FINDINGS Studies evaluating pediatric heart failure are limited by its rarity and the heterogeneity of underlying conditions. However, recent reports have provided new data on the epidemiology, presentation, and outcomes of children with heart failure. SUMMARY The recent studies reviewed here highlight the significant diagnostic and management challenges that pediatric heart failure presents given the variety and lack of specificity of its presenting signs, symptoms, and diagnostic work-up. This review provides the ED physician with a framework for understanding of pediatric heart failure to allow for efficient diagnosis and management of these patients. The primary focus of this review is heart failure in structurally normal hearts.
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Zinn MD, Wallendorf MJ, Simpson KE, Osborne AD, Kirklin JK, Canter CE. Impact of routine surveillance biopsy intensity on the diagnosis of moderate to severe cellular rejection and survival after pediatric heart transplantation. Pediatr Transplant 2018; 22:e13131. [PMID: 29377465 PMCID: PMC5903932 DOI: 10.1111/petr.13131] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2017] [Indexed: 11/29/2022]
Abstract
Data are lacking on RSB intensity and outcomes after pediatric heart transplantation. PHTS centers received a survey on RSB practices from 2005 to present. PHTS data were obtained for 2010-2013 and integrated with center-matched survey responses for analysis. Survey response rate was 82.6% (38/46). Centers were classified as low-, moderate-, and high-intensity programs based on RSB frequency (0-more than 8 RSB/y). RSB intensity decreased with increasing time from HT. Age at HT impacted RSB intensity mostly in year 1, with little to no impact in later years. Most centers have not replaced RSB with non-invasive methods, but many added ECHO and biomarker monitoring. Higher RSB intensity was not associated with decreased 4-year mortality (P=.63) or earlier detection of moderate to severe (ISHLT grade 2R/3R) cellular rejection (RSBMSR) in the first year (P=.87). First-year RSBMSR incidence did not differ with intensity or age at HT. Significant variability exists in RSB intensity, but with no impact on timing and incidence of RSBMSR or 4-year mortality. Reduction in RSB frequency may be safe in certain patients after pediatric HT.
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Affiliation(s)
- Matthew D. Zinn
- Division of Cardiology; Department of Pediatrics; The University of Pittsburgh Medical Center; Pittsburgh PA USA
- Children's Hospital of Pittsburgh of UPMC; Pittsburgh PA USA
| | - Michael J. Wallendorf
- Division of Biostatistics; Washington University School of Medicine; St. Louis MO USA
| | - Kathleen E. Simpson
- Saint Louis Children's Hospital; St. Louis MO USA
- Division of Cardiology; Department of Pediatrics; Washington University School of Medicine; St. Louis MO USA
| | - Ashley D. Osborne
- Division of Cardiology; Department of Pediatrics; Washington University School of Medicine; St. Louis MO USA
| | - James K. Kirklin
- Division of Cardiothoracic Surgery; Department of Surgery; The University of Alabama at Birmingham; Birmingham AL USA
| | - Charles E. Canter
- Saint Louis Children's Hospital; St. Louis MO USA
- Division of Cardiology; Department of Pediatrics; Washington University School of Medicine; St. Louis MO USA
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Zhang AY, Yang L, Guo P, Li S, Ao X, Xu F, Tan L. B-type brain natriuretic peptide as a measure of the severity of hand-foot-mouth disease: a case-control study. BMC Infect Dis 2017; 17:651. [PMID: 28962547 PMCID: PMC5622520 DOI: 10.1186/s12879-017-2734-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/13/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Hand-foot-mouth disease (HFMD) is an acute infectious disease caused by enteroviruses, and HFMD complicated by cardiopulmonary failure has a high mortality. B type natriuretic peptide (BNP) is widely applied in monitoring cardiovascular disorders, and thus, we investigated whether this index was associated with the severity of HFMD and the outcome in severe HFMD. METHODS Serum BNP, lactate, and glucose levels as well as white blood cell (WBC) count, PaO2/FiO2, and cardiac output (CO) were analyzed in the 83 enrolled HFMD patients according to different conditions (common, severe, and critical; with and without complication; and survivors and non-survivors). The control group consisted of 29 patients with respiratory tract infections. RESULTS No significant differences in CO were observed between the groups. Serum lactate, glucose, BNP, and WBC levels in the critical group were significantly higher than those in the severe, common, and control groups (p < 0.01 or 0.05). The PaO2/FiO2 ratio was significantly lower in the critical group (214.286 ± 154.346) than in the other groups. According to logistic regression analysis, the areas under the curve for serum BNP, glucose, and PaO2/FiO2 of the patients with complications were 0.774, 0.738, and 0.75, respectively. Moreover, the BNP level was significantly higher in HFMD patients with complications and non-survivors. CONCLUSION Our findings indicate that BNP could be a biochemical indicator for severe (critical) HFMD and used for prognosis in terms of complications and death. Combined with Glu and PaO2/FiO2 and clinical symptoms of HFMD, the value of BNP as an indicator became more precise and specific. Our results may provide another valuable, objective biochemical indicator for severe HFMD. TRIAL REGISTRATION NUMBER ChiCTR-DDT-14004576 . Name of registry: Chinese Clinical Trial Registry. Date of registration: 2014-09-21.
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Affiliation(s)
- AYuan Zhang
- Department of Emergency, Children’s Hospital of Chongqing Medical University, No. 136, Zhongshan 2 Road, Yuzhong district, Chongqing, 400014 China
- Department of Respiratory Medicine, Sichuan Provincial Hospital For Women & Children, Chongqing, China
| | - Lin Yang
- Department of Emergency, Children’s Hospital of Chongqing Medical University, No. 136, Zhongshan 2 Road, Yuzhong district, Chongqing, 400014 China
| | - Pengfei Guo
- Department of Emergency, Children’s Hospital of Chongqing Medical University, No. 136, Zhongshan 2 Road, Yuzhong district, Chongqing, 400014 China
| | - Shaojun Li
- Department of Emergency, Children’s Hospital of Chongqing Medical University, No. 136, Zhongshan 2 Road, Yuzhong district, Chongqing, 400014 China
| | - Xiaoxiao Ao
- Department of Emergency, Children’s Hospital of Chongqing Medical University, No. 136, Zhongshan 2 Road, Yuzhong district, Chongqing, 400014 China
| | - Feng Xu
- Pediatric Intensive Care Unit, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Liping Tan
- Department of Emergency, Children’s Hospital of Chongqing Medical University, No. 136, Zhongshan 2 Road, Yuzhong district, Chongqing, 400014 China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
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Qu J, Liang H, Zhou N, Li L, Wang Y, Li J, Cui Y. Perioperative NT-proBNP level: Potential prognostic markers in children undergoing congenital heart disease surgery. J Thorac Cardiovasc Surg 2017; 154:631-640. [DOI: 10.1016/j.jtcvs.2016.12.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 12/16/2016] [Accepted: 12/29/2016] [Indexed: 11/17/2022]
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The potential of novel peptides in the management of children with Congenital Heart Disease: Above and beyond the BNP. PROGRESS IN PEDIATRIC CARDIOLOGY 2017. [DOI: 10.1016/j.ppedcard.2016.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Association of B-type natriuretic peptide with coronary plaque subtypes detected by coronary computed tomography angiography in patients with stable chest pain. Int J Cardiovasc Imaging 2017; 33:1599-1606. [PMID: 28396960 DOI: 10.1007/s10554-017-1132-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 04/03/2017] [Indexed: 01/18/2023]
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46
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Kanazawa T, Egi M, Toda Y, Shimizu K, Sugimoto K, Iwasaki T, Morimatsu H. Perioperative Brain Natriuretic Peptide in Pediatric Cardiac Surgery Patients: Its Association With Postoperative Outcomes. J Cardiothorac Vasc Anesth 2017; 31:537-542. [DOI: 10.1053/j.jvca.2016.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Indexed: 11/11/2022]
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Makil ES, Tang X, Frazier EA, Collins RT. Alkaline Phosphatase: A Biomarker of Cardiac Function in Pediatric Patients. Pediatr Cardiol 2017; 38:762-769. [PMID: 28184975 DOI: 10.1007/s00246-017-1577-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/20/2017] [Indexed: 11/26/2022]
Abstract
Myocardial dysfunction and heart failure are common in pediatric patients with congenital and acquired heart disease. Alkaline phosphatase (AP) has been suggested as a biomarker for myocardial dysfunction after Fontan operation. We hypothesized that pediatric patients with myocardial dysfunction requiring orthotopic heart transplant (OHT) have diminished AP compared to normal. A retrospective review was performed in all patients who underwent OHT at Arkansas Children's Hospital between January 2007 and October 2012. Anatomic diagnoses, therapeutic interventions, and ventricular ejection fraction (EF) were recorded. Z scores for AP levels in the study group were determined by comparing the observed AP levels to age- and gender-matched normative values. T tests were performed to compare the mean AP Z score prior to and after OHT. p values <0.05 were considered statistically significant. During the study period, 124 OHTs were performed. Complete study data were available and analyzed from 71/124 patients (mean age at OHT 3.9 years; 51% female). The mean AP Z score was significantly lower in the study group prior to OHT compared to normal (p < 0.0001). The initiation of ACE inhibitor therapy prior to OHT was associated with a significant increase in AP and the ventricular EF (p < 0.001 for both). Treatment with milrinone was associated with an increase in EF. AP is significantly lower in pediatric patients with myocardial dysfunction prior to OHT compared to normal. AP increases significantly after the initiation of therapies to improve myocardial function. Diminished AP is an indicator of myocardial dysfunction in pediatric patients.
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Affiliation(s)
- Elizabeth S Makil
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Arkansas Children's Hospital, 1 Children's Way, Mail Slot 512-3, Little Rock, AR, 72202, USA
| | - Xinyu Tang
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Arkansas Children's Hospital, 1 Children's Way, Mail Slot 512-3, Little Rock, AR, 72202, USA
| | - Elizabeth A Frazier
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Arkansas Children's Hospital, 1 Children's Way, Mail Slot 512-3, Little Rock, AR, 72202, USA
| | - R Thomas Collins
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
- Arkansas Children's Hospital, 1 Children's Way, Mail Slot 512-3, Little Rock, AR, 72202, USA.
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Paolino A, Hussain T, Pavon A, Velasco MN, Uribe S, Ordoñez A, Valverde I. NT-proBNP as Marker of Ventricular Dilatation and Pulmonary Regurgitation After Surgical Correction of Tetralogy of Fallot: A MRI Validation Study. Pediatr Cardiol 2017; 38:324-331. [PMID: 27872995 DOI: 10.1007/s00246-016-1516-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/10/2016] [Indexed: 01/23/2023]
Abstract
The goal of this study is to evaluate whether NT-proBNP plasma levels may help as a screening biomarker for monitoring right ventricular dilatation, pulmonary regurgitation and the onset of heart failure in patients with repaired Tetralogy of Fallot. Our single-centre observational prospective study involved 43 patients (15.1 years, SD = 8) with corrected Tetralogy of Fallot. Data collection included: clinical parameters (electrocardiogram, chest X-ray, NYHA scale, time since last surgery), biochemistry (NT-proBNP levels) and MRI values (ventricular volumetry, pulmonary flow assessment). Mean time since last surgery was 13.5 years (SD = 7.8). There was a statistically significant correlation between the NT-proBNP levels (187.4 pg/ml, SD = 154.9) and right ventricular dilatation for both the right ventricular end-diastolic volume (124.9 ml/m2, SD = 31.2) (Pearson = 0.19, p < 0.01) and end-systolic volume (56.1 ml/m2, SD = 18.8) (Pearson = 0.21, p < 0.01) and also with the pulmonary regurgitation fraction (36.5%, SD = 16, Pearson = 0.12, p < 0.01). No significant correlation was found between NT-proBNP and right ventricular ejection fraction (54.6%, SD = 10.6, Pearson = -0.07), left ventricular ejection fraction (59.9%, SD = 7.1, Pearson = -0.18) or any clinical parameters. The receiver operating curve analysis evidenced that a NT-proBNP cut-off value above 133.2 pg/ml predicted the presence of dilated right ventricular end-diastolic and end-systolic volumes over centile 95 (sensitivity 82 and 83% and specificity 93 and 79%, respectively). In conclusion, in patients with surgically corrected Tetralogy of Fallot, NT-proBNP levels correlate with right ventricular dilatation and the degree of pulmonary regurgitation. Ambulatory determination of NT-proBNP might be an easy, readily available and cost-effective alternative for MRI follow-up evaluation of these patients.
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Affiliation(s)
- Annalisa Paolino
- Paediatric Cardiology Unit, Hospital Virgen del Rocio, Seville, Spain
| | - Tarique Hussain
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St. Thomas' Hospital, King's College London, London, UK.,Department of Paediatrics, Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - Antonio Pavon
- Neonate Intensive Care Unit, Hospital Virgen del Rocio, Seville, Spain
| | - Maria Nieves Velasco
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St. Thomas' Hospital, King's College London, London, UK
| | - Sergio Uribe
- Radiology Department and Biomedical Imaging Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Antonio Ordoñez
- Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Hospital Virgen del Rocio/CSIC/University of Seville, Avda. Manuel Siurot, s/n, 41013, Seville, Spain
| | - Israel Valverde
- Paediatric Cardiology Unit, Hospital Virgen del Rocio, Seville, Spain. .,Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St. Thomas' Hospital, King's College London, London, UK. .,Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Hospital Virgen del Rocio/CSIC/University of Seville, Avda. Manuel Siurot, s/n, 41013, Seville, Spain.
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Sadlecki P, Grabiec M, Walentowicz-Sadlecka M. Prenatal Clinical Assessment of NT-proBNP as a Diagnostic Tool for Preeclampsia, Gestational Hypertension and Gestational Diabetes Mellitus. PLoS One 2016; 11:e0162957. [PMID: 27685993 PMCID: PMC5042470 DOI: 10.1371/journal.pone.0162957] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/31/2016] [Indexed: 12/02/2022] Open
Abstract
Common complications of pregnancy include preeclampsia (PE), gestational hypertension (GH) and gestational diabetes mellitus (GDM). Hypertensive disorders (PE/GH) and GDM may result in greater maternal, fetal and neonatal morbidity and mortality. Women with PE/GH, one of the most common causes of heart burden in an obstetrical setting, present with elevated serum levels of BNP and NT-proBNP. The aim of this study was to shed more light on the role of NT-proBNP in pathophysiology of PE, GH and GDM. The study included 156 pregnant women with singleton pregnancies. A total of 26 women developed arterial hypertension during pregnancy, 14 were diagnosed with PE, and GDM was detected in 81 patients. The control group included 35 women with uncomplicated pregnancies, normal arterial blood pressure and normal glucose concentrations. Patients with GH presented with significantly higher serum concentrations of NT-proBNPthan normotensive women (65.5 vs. 37.4 pg/ml; p = 0.0136). Serum levels of NT-proBNP in patients with PE were the highest of all the analyzed subsets, being significantly higher than in women without this condition (89.00 vs. 37.4pg/ml,p = 0,0136). However, women with and without GDM did not differ significantly in terms of their serum NT-proBNPconcentrations. Serum NT-proBNP (pg/ml) (p = 0.0001) and BMI (p<0.0001) turned out to be independent predictors of GH on multivariate logistic regression analysis.Moreover, serum NT-proBNP (pg/ml) was identified as an independent indicator of PE (p = 0.0016). A significant inverse correlation was found between birth weight and maternal serum NT-proBNP concentrations. In our opinion, NT-proBNP can be a useful clinical marker of GH and PE. Determination of NT-proBNP levels may be helpful in identification of patients with PE and GH and in their qualification for intensive treatment; this in turn, may be reflected by better neonatal outcomes.
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Affiliation(s)
- Pawel Sadlecki
- Department of Obstetrics and Gynecology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University of Torun, Torun, Poland
- * E-mail:
| | - Marek Grabiec
- Department of Obstetrics and Gynecology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University of Torun, Torun, Poland
| | - Malgorzata Walentowicz-Sadlecka
- Department of Obstetrics and Gynecology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University of Torun, Torun, Poland
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Cantinotti M, Giordano R, Scalese M, Molinaro S, Della Pina F, Storti S, Arcieri L, Murzi B, Marotta M, Pak V, Poli V, Iervasi G, Kutty S, Clerico A. Prognostic role of BNP in children undergoing surgery for congenital heart disease: analysis of prediction models incorporating standard risk factors. Clin Chem Lab Med 2016; 53:1839-46. [PMID: 25901715 DOI: 10.1515/cclm-2014-1084] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/17/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND The routine use of brain natriuretic peptide (BNP) in pediatric cardiac surgery remains controversial. Our aim was to test whether BNP adds information to predict risk in pediatric cardiac surgery. METHODS In all, 587 children undergoing cardiac surgery (median age 6.3 months; 1.2-35.9 months) were prospectively enrolled at a single institution. BNP was measured pre-operatively, on every post-operative day in the intensive care unit, and before discharge. The primary outcome was major complications and length ventilator stay >15 days. A first risk prediction model was fitted using Cox proportional hazards model with age, body surface area and Aristotle score as continuous predictors. A second model was built adding cardiopulmonary bypass time and arterial lactate at the end of operation to the first model. Then, peak post-operative log-BNP was added to both models. Analysis to test discrimination, calibration, and reclassification were performed. RESULTS BNP increased after surgery (p<0.001), peaking at a mean of 63.7 h (median 36 h, interquartile range 12-84 h) post-operatively and decreased thereafter. The hazard ratios (HR) for peak-BNP were highly significant (first model HR=1.40, p=0.006, second model HR=1.44, p=0.008), and the log-likelihood improved with the addition of BNP at 12 h (p=0.006; p=0.009). The adjunction of peak-BNP significantly improved the area under the ROC curve (first model p<0.001; second model p<0.001). The adjunction of peak-BNP also resulted in a net gain in reclassification proportion (first model NRI=0.089, p<0.001; second model NRI=0.139, p=0.003). CONCLUSIONS Our data indicates that BNP may improve the risk prediction in pediatric cardiac surgery, supporting its routine use in this setting.
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