1
|
Soveral I, Guirado L, Escobar-Diaz MC, Alcaide MJ, Martínez JM, Rodríguez-Sureda V, Bijnens B, Antolin E, Llurba E, Bartha JL, Gómez O, Crispi F. Cord Blood Cardiovascular Biomarkers in Left-Sided Congenital Heart Disease. J Clin Med 2022; 11:jcm11237119. [PMID: 36498692 PMCID: PMC9737470 DOI: 10.3390/jcm11237119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/19/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
Fetal echocardiography has limited prognostic ability in the evaluation of left-sided congenital heart defects (left heart defects). Cord blood cardiovascular biomarkers could improve the prognostic evaluation of left heart defects. A multicenter prospective cohort (2013−2019) including fetuses with left heart defects (aortic coarctation, aortic stenosis, hypoplastic left heart, and multilevel obstruction (complex left heart defects) subdivided according to their outcome (favorable vs. poor), and control fetuses were evaluated in the third trimester of pregnancy at three referral centers in Spain. Poor outcome was defined as univentricular palliation, heart transplant, or death. Cord blood concentrations of N-terminal precursor of B-type natriuretic peptide, Troponin I, transforming growth factor β, placental growth factor, and soluble fms-like tyrosine kinase-1 were determined. A total of 45 fetuses with left heart defects (29 favorable and 16 poor outcomes) and 35 normal fetuses were included, with a median follow-up of 3.1 years (interquartile range 1.4−3.9). Left heart defects with favorable outcome showed markedly increased cord blood transforming growth factor β (normal heart median 15.5 ng/mL (6.8−21.4) vs. favorable outcome 51.7 ng/mL (13.8−73.9) vs. poor outcome 25.1 ng/mL (6.9−39.0), p = 0.001) and decreased placental growth factor concentrations (normal heart 17.9 pg/mL (13.8−23.9) vs. favorable outcome 12.8 pg/mL (11.7−13.6) vs. poor outcome 11.0 pg/mL (8.8−15.4), p < 0.001). Poor outcome left heart defects had higher N-terminal precursor of B-type natriuretic peptide (normal heart 508.0 pg/mL (287.5−776.3) vs. favorable outcome 617.0 pg/mL (389.8−1087.8) vs. poor outcome 1450.0 pg/mL (919.0−1645.0), p = 0.001) and drastically reduced soluble fms-like tyrosine kinase-1 concentrations (normal heart 1929.7 pg/mL (1364.3−2715.8) vs. favorable outcome (1848.3 pg/mL (646.9−2313.6) vs. poor outcome 259.0 pg/mL (182.0−606.0), p < 0.001). Results showed that fetuses with left heart defects present a distinct cord blood biomarker profile according to their outcome.
Collapse
Affiliation(s)
- Iris Soveral
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), 08028 Barcelona, Spain
- Obstetrics Department, Hospital General de Hospitalet, 08906 Barcelona, Spain
| | - Laura Guirado
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), 08028 Barcelona, Spain
| | - Maria C. Escobar-Diaz
- Pediatric Cardiology Department, Sant Joan de Déu Hospital, Esplugues de Llobregat, 08950 Barcelona, Spain
- Cardiovascular Research Group, Sant Joan de Deu Research Institute, Esplugues de Llobregat, 08028 Barcelona, Spain
| | - María José Alcaide
- Laboratory Medicine Department, Hospital Universitario La Paz, 28046 Madrid, Spain
- Research Institute IdiPAZ, 28029 Madrid, Spain
| | - Josep Maria Martínez
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), 08028 Barcelona, Spain
- Facultat de Medicina i Ciencies de la Salut, Universitat de Barcelona, 08007 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), 28029 Madrid, Spain
| | - Víctor Rodríguez-Sureda
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), 08028 Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), 28029 Madrid, Spain
| | - Bart Bijnens
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Catalan Institution for Research and Advanced Studies ICREA, 08010 Barcelona, Spain
| | - Eugenia Antolin
- Research Institute IdiPAZ, 28029 Madrid, Spain
- Obstetrics and Gynecology Department, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Elisa Llurba
- Obstetrics and Gynecology Department, Santa Creu i Sant Pau University Hospital, 08025 Barcelona, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Jose L. Bartha
- Research Institute IdiPAZ, 28029 Madrid, Spain
- Obstetrics and Gynecology Department, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Olga Gómez
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), 08028 Barcelona, Spain
- Facultat de Medicina i Ciencies de la Salut, Universitat de Barcelona, 08007 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-932-27-9333
| | - Fàtima Crispi
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), 08028 Barcelona, Spain
- Facultat de Medicina i Ciencies de la Salut, Universitat de Barcelona, 08007 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), 28029 Madrid, Spain
| |
Collapse
|
2
|
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.
Collapse
|
3
|
Left Ventricular Systolic Impairment after Pediatric Cardiac Surgery Assessed by STE Analysis. Healthcare (Basel) 2021; 9:healthcare9101338. [PMID: 34683018 PMCID: PMC8544436 DOI: 10.3390/healthcare9101338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Speckle-tracking echocardiography (STE) has gained increasing value in the evaluation of congenital heart diseases (CHD); however, its use in pediatric cardiac surgery is limited. Aim: To evaluate left ventricular (LV) systolic impairment after biventricular pediatric cardiac surgery by STE strain (ε) analysis. Methods: We prospectively enrolled 117 children undergoing cardiac surgery for CHD. Echocardiography was performed at four different times: pre-operatively, 12–36 h (Time 1), 3–5 days (Time 2), and 6–8 days (Time 3). Images were obtained in the 4-2-and 3 apical chamber’s views to derive LV global and regional (basal/mid/apical) ε values. Results: At different postoperative times, we performed 320 examinations in 117 children (mean age: 2.4 ± 3.9, range: 0–16 years); 117 age-matched healthy children served as controls. All global, basal, and mid LVε values decreased after surgery; the lowest values being at Time 1 (p < 0.0001), which increased thereafter. At discharge, all global, basal, and mid LVε values remained lower than in pre-operative and healthy children (p < 0.05). Instead, apical segments (lowest at baseline) increased after surgery (p < 0.0001) but remained lower compared to controls. LV ejection fraction (LVEF) decreased at Time 1 (p = 0.0004) but promptly recovered to Time 2 and normalized at Time 3. Conclusions: STE ε analysis revealed a significant LV systolic impairment after surgery with amelioration thereafter but incomplete normalization at discharge. Base-apex differences emerged with apical segments that, contrary to all the other regions, showed relative hypercontractility after surgery. The slower recovery of LVε values compared to LVEF suggests that STE ε analysis may be more accurate for the follow-up of mild LV post-surgical impairment.
Collapse
|
4
|
Mori Y, Nakashima Y, Kaneko S, Inoue N, Murakami T. Risk Factors for Cardiac Adverse Events in Infants and Children with Complex Heart Disease Scheduled for Bi-ventricular Repair: Prognostic Value of Pre-operative B-Type Natriuretic Peptide and High-Sensitivity Troponin T. Pediatr Cardiol 2020; 41:1756-1765. [PMID: 32808054 DOI: 10.1007/s00246-020-02437-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/07/2020] [Indexed: 11/26/2022]
Abstract
Few reports have described the prognostic value of measuring both B-type natriuretic peptides (BNP) and high-sensitivity troponin T (hs-TnT) in pediatric patients with complex congenital heart disease (CHD) undergoing surgery. We assessed demographic, hemodynamic, and laboratory data, including BNP and hs-TnT levels, for the prediction of cardiac adverse events in 85 patients. Cardiac adverse events were defined as death, cardiac arrest, worsening heart failure requiring inotropic agents and/or respiratory support, and unscheduled surgery/intervention either within or after 12 months of surgery. There were 17 cardiac adverse events. Of the demographic variables, low birth weight (< 2500 g: Odds ratio [OR], 5.97; 95% confidential interval [CI] 1.48-24.0; p = 0.001) and Ross/New York Heart Association [NYHA] class (≥ 2.0) (OR 12.7; 95% CI 3.08-52.7; p = 0.0004) were strongly association with cardiac adverse events. Among hemodynamic and laboratory variables, preoperative BNP (OR 14.04; 95% CI 2.15-91.7; p = 0.001) and hs-TnT levels (OR 16.66; 95% CI 2.27-122; p = 0.002) were found to be independent risk factors. Receiver operating characteristic analysis determined BNP and hs-TnT levels of 60.9 pg/mL and 0.025 ng/mL, respectively, to be markers of high risk. Kaplan-Meier analysis demonstrated significant differences in the freedom from cardiac adverse events between Group A (BNP or hs-TnT elevated, n = 26) and Group B (both biomarkers elevated, n = 19; log-rank, p < 0.001). In conclusion, low birth weight (< 2500 g) and Ross/NYHA class ≥ 2.0 are strongly associated with cardiac adverse events. Preoperative BNP and hs-TnT also provide prognostic information in patients with complex CHD scheduled for surgery. Using both markers in combination predicts cardiac adverse events better than using either separately.
Collapse
Affiliation(s)
- Yoshiki Mori
- Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan.
| | - Yasumi Nakashima
- Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Sachie Kaneko
- Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Nao Inoue
- Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Tomotaka Murakami
- Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| |
Collapse
|
5
|
Clausen H, Norén E, Valtonen S, Koivu A, Sairanen M, Liuba P. Evaluation of Circulating Cardiovascular Biomarker Levels for Early Detection of Congenital Heart Disease in Newborns in Sweden. JAMA Netw Open 2020; 3:e2027561. [PMID: 33263763 PMCID: PMC7711323 DOI: 10.1001/jamanetworkopen.2020.27561] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Congenital heart disease (CHD) is the most common congenital malformation in humans worldwide. Circulating cardiovascular biomarkers could potentially improve the early detection of CHD, even in asymptomatic newborns. OBJECTIVES To assess the performance of a dried blood spot (DBS) test to measure the cardiovascular biomarker amino terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP) levels in newborns and to compare DBS with standard EDTA analysis in control newborns during the first week of life. DESIGN, SETTING, AND PARTICIPANTS This diagnostic study was conducted in a single regional pediatric service in southern Sweden. Healthy, term neonates born between July 1, 2018, and May 31, 2019, were prospectively enrolled and compared against retrospectively identified newborns with CHD born between September 1, 2003, and September 30, 2019. Neonates who required inpatient treatment beyond the standard postnatal care were excluded. EXPOSURE New DBS test for NT-proBNP quantification in newborns that used 3 μL of blood vs the current screening standard. MAIN OUTCOMES AND MEASURES Performance of the new test and when combined with pulse oximetry screening was measured by receiver operating characteristic curve analysis. Performance of the new test and EDTA screening was compared using Pearson linear correlation analysis. RESULTS The DBS samples of 115 neonates (81 control newborns and 34 newborns with CHD, of whom 63 were boys [55%] and the mean [SD] gestational age was 39.6 [1.4] weeks) were analyzed. The new NT-proBNP test alone identified 71% (n = 24 of 34) of all CHD cases and 68% (n = 13 of 19) of critical CHD cases as soon as 2 days after birth. Detection of any CHD type improved to 82% (n = 28 of 34 newborns) and detection of critical CHD improved to 89% (n = 17 of 19 newborns) when combined pulse oximetry screening and NT-proBNP test results were used. Performance of the NT-proBNP test was excellent when control newborns were matched to newborns with CHD born between July 1, 2018, and May 31, 2019 (area under the curve, 0.96; SE, 0.027; 95% CI, 0.908-1.0; asymptotic P < .05). CONCLUSIONS AND RELEVANCE This study found that NT-proBNP assay using minimal DBS samples appears to be timely and accurate in detecting CHD in newborns and to discriminate well between healthy newborns and newborns with various types of CHD. This finding warrants further studies in larger cohorts and highlights the potential of NT-proBNP to improve neonatal CHD screening.
Collapse
Affiliation(s)
- Henning Clausen
- Regional Paediatric Cardiology Service, Department of Paediatrics, University Teaching Hospital Ryhov, Jönköping, Sweden
- Children’s Heart Centre, Scania University Hospital and Lund University, Lund, Sweden
| | - Elisabeth Norén
- Clinical Laboratory Science, University Teaching Hospital Ryhov, Jönköping, Sweden
| | - Salla Valtonen
- Department of Chemistry, University of Turku, Turku, Finland
| | - Aki Koivu
- Research and Development Division, PerkinElmer, Turku, Finland
| | - Mikko Sairanen
- Research and Development Division, PerkinElmer, Turku, Finland
| | - Petru Liuba
- Children’s Heart Centre, Scania University Hospital and Lund University, Lund, Sweden
| |
Collapse
|
6
|
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.
Collapse
|
7
|
Lin F, Zheng L, Cui Y, Chen W, Gupta RK, Li H, Chen X, Xia H, Liang H. Prognostic value of perioperative NT-proBNP after corrective surgery for pediatric congenital heart defects. BMC Pediatr 2019; 19:497. [PMID: 31842815 PMCID: PMC6913023 DOI: 10.1186/s12887-019-1830-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/11/2019] [Indexed: 11/18/2022] Open
Abstract
Background It is critically important to assess the prognostic value of NT-proBNP in the form of repeated measures among children undergoing surgery for congenital heart defects (CHD). The aim of the present study is to assess the value of repeated perioperative NT-proBNP in evaluating the time dependent and temporal trajectory in prognostics diagnosis during the perioperative period in a large series of children with CHD. Methods Repeated measures of NT-proBNP from 329 consecutive children with CHD were obtained before and 1, 12, and 36 h after surgery, respectively. For fully utilizing longitudinal characteristics, we employed parallel cross-sectional logistic regression, a two stage mixed effect model and trajectories over time analysis to mine the predictive value of perioperative NT-proBNP on the binary outcome of prolonged intensive care unit (ICU) stay. Results The two stage mixed effects model confirmed that both the mean NT-proBNP level (aOR = 1.46, P = 0.001) and the time trends had prognostic value on the prediction of prolonged ICU stay. In the fully adjusted logistic regression analyses based on gaussian distributions, “rapidly rising NT-proBNP” put the subjects at 5.4-times higher risk of prolonged ICU stay compared with “slowly rising” group (aOR = 5.40, P = 0.003). Conclusions Comprehensive assessment of the time dependent and temporal trajectory in perioperative NT-proBNP, indicated by repeated measurements, can provide more accurate identification of children with higher risk of prolonged ICU stay after CHD surgery.
Collapse
Affiliation(s)
- Fangqin Lin
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lingling Zheng
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yanqin Cui
- Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Weidan Chen
- Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ramit Kumar Gupta
- Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huixian Li
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xinxin Chen
- Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huimin Xia
- Department of Pediateric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huiying Liang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
| |
Collapse
|
8
|
Cantinotti M, Giordano R, Scalese M, Marchese P, Franchi E, Viacava C, Molinaro S, Assanta N, Koestenberger M, Kutty S, Gargani L, Ait-Ali L. Prognostic Value of a New Lung Ultrasound Score to Predict Intensive Care Unit Stay in Pediatric Cardiac Surgery. Ann Thorac Surg 2019; 109:178-184. [PMID: 31400328 DOI: 10.1016/j.athoracsur.2019.06.057] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/23/2019] [Accepted: 06/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) in pediatric cardiac surgery is gaining consensus. We (1) evaluated the prognostic value of a new LUS-score in pediatric cardiac surgery, and (2) compared LUS-score to conventional risk factors including age, The Society of Thoracic Surgeons/European Association of Cardio-Thoracic Surgery (STAT) score, cardiopulmonary bypass time, and prognostic biomarkers including brain natriuretic peptide and cystatin-C. METHODS LUS examinations were performed in 237 children (median age, 0.55 years; interquartile range, 0.09-4.15 years) at 12 to 36 hours after surgery. For each hemithorax, 3 areas (anterior/lateral/posterior) were evaluated in the upper and lower halves, constituting 12 total scanning areas. For each site a score was assigned: 0 (rare B lines), 1 (separated B lines), 2 (coalescent B lines), 3 (loss of aeration), and total LUS score was calculated as sum of all sites. The primary endpoints were intensive care unit length of stay and extubation time. RESULTS The mean total LUS score was 12.88 ± 6.41 (range, 0-26) and was higher in newborns (16.77 ± 5.25) compared with older children (5.36 ± 5.57; P < .001). On univariate analysis, LUS score was associated inversely with age (beta 0.26; P = .004) and body surface area (beta 3.41 P = .006) and positively with brain natriuretic peptide (beta 1.65; P < .001) and cystatin-C (beta 2.41; P < .001). The LUS score, when added as continuous predictor to a conventional risk model (age, STAT score, and cardiopulmonary bypass time) emerged significant both for intensive care unit length of stay (beta 0.145, P = .047) and extubation time (beta 1.644; P = .024). When single quadrants were analyzed, only anterior LUS score was significant (intensive care unit length of stay beta, 0.471; P = .020; extubation time beta 5.530; P = .007). CONCLUSIONS Our data show the prognostic incremental value of a new LUS score over traditional risk factors in pediatric cardiac surgery.
Collapse
Affiliation(s)
- Massimiliano Cantinotti
- Fondazione CNR-Regione Toscana G. Monasterio (FTGM), Massa, Pisa, Italy; Institute of Clinical Physiology, National Research Institute, Pisa, Italy
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy.
| | - Marco Scalese
- Institute of Clinical Physiology, National Research Institute, Pisa, Italy
| | - Pietro Marchese
- Fondazione CNR-Regione Toscana G. Monasterio (FTGM), Massa, Pisa, Italy
| | - Eliana Franchi
- Fondazione CNR-Regione Toscana G. Monasterio (FTGM), Massa, Pisa, Italy
| | - Cecilia Viacava
- Fondazione CNR-Regione Toscana G. Monasterio (FTGM), Massa, Pisa, Italy
| | - Sabrina Molinaro
- Institute of Clinical Physiology, National Research Institute, Pisa, Italy
| | - Nadia Assanta
- Fondazione CNR-Regione Toscana G. Monasterio (FTGM), Massa, Pisa, Italy
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria
| | - Shelby Kutty
- Helen B. Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Institute, Pisa, Italy
| | - Lamia Ait-Ali
- Institute of Clinical Physiology, National Research Institute, Pisa, Italy
| |
Collapse
|
9
|
Bobillo-Perez S, Jordan I, Corniero P, Balaguer M, Sole-Ribalta A, Esteban ME, Esteban E, Cambra FJ. Prognostic value of biomarkers after cardiopulmonary bypass in pediatrics: The prospective PANCAP study. PLoS One 2019; 14:e0215690. [PMID: 31206538 PMCID: PMC6576774 DOI: 10.1371/journal.pone.0215690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/05/2019] [Indexed: 01/03/2023] Open
Abstract
Objective To assess the usefulness of procalcitonin, pro-adrenomedullin and pro-atrial natriuretic peptide as predictors of need for mechanical ventilation and postoperative complications (need for inotropic support and bacterial infection) in critically ill pediatric patients after cardiopulmonary bypass. Design A prospective, observational study Setting Pediatric intensive care unit. Patients Patients under 18 years old admitted after cardiopulmonary bypass. Measuraments and main results Serum levels of procalcitonin, pro-adrenomedullin and pro-atrial natriuretic peptide were determined immediately after bypass and at 24–36 hours. Their values were correlated with the need for mechanical ventilation, inotropic support and bacterial infection. One hundred eleven patients were recruited. Septal defects (30.6%) and cardiac valve disease (17.1%) were the most frequent pathologies. 40.7% required mechanical ventilation, 94.6% inotropic support and 15.3% presented invasive bacterial infections. Pro-adrenomedullin and pro-atrial natriuretic peptide showed significant high values in patients needing mechanical ventilation. Cut-off values higher than 1.22 nmol/L and 215.3 pmol/L, respectively for each biomarker, may indicate need for mechanical ventilation with an AUC of 0.721 and 0.746 at admission and 0.738 and 0.753 at 24–36 hours, respectively but without statistical differences. Pro-adrenomedullin and procalcitonin showed statistically significant high values in patients with bacterial infections. Conclusions After bypass, pro-adrenomedullin and pro-atrial natriuretic peptide are suitable biomarkers to predict the need for mechanical ventilation. Physicians should be alert if the values of these markers are high so as not to progress to early extubation. Procalcitonin is useful for predicting bacterial infection. This is a preliminary study and more clinical studies should be done to confirm the value of pro-adrenomedullin and pro-atrial natriuretic peptide as biomarkers after cardiopulmonary bypass.
Collapse
Affiliation(s)
- Sara Bobillo-Perez
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Pediatric Intensive Care Research Group, Institut Recerca Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Iolanda Jordan
- Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Pediatric Intensive Care Research Group, Institut Recerca Hospital Sant Joan de Déu, CIBERESP, Barcelona, Spain
- * E-mail:
| | - Patricia Corniero
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Monica Balaguer
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Anna Sole-Ribalta
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Maria Esther Esteban
- Section of Zoology and Biological Anthropology, Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca de la Biodiversitat (IRBio), Universitat de Barcelona, Barcelona, Spain
| | - Elisabeth Esteban
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | | |
Collapse
|
10
|
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]
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Cantinotti M, Clerico A. The prognostic role of natriuretic peptides in children undergoing cardiac surgery: Can acute kidney injury affect their accuracy? J Thorac Cardiovasc Surg 2018; 155:2617-2618. [DOI: 10.1016/j.jtcvs.2018.02.004] [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] [Received: 01/25/2018] [Accepted: 02/05/2018] [Indexed: 12/01/2022]
|
13
|
Impact of underlying heart disease per se on the utility of preoperative NT-proBNP in adult cardiac surgery. PLoS One 2018; 13:e0192503. [PMID: 29420603 PMCID: PMC5805306 DOI: 10.1371/journal.pone.0192503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/24/2018] [Indexed: 12/14/2022] Open
Abstract
Objective The primary aim was to investigate the role of underlying heart disease on preoperative NT-proBNP levels in patients admitted for adult cardiac surgery, after adjusting for the known confounders age, gender, obesity and renal function. The second aim was to investigate the predictive value of preoperative NT-proBNP with regard to severe postoperative heart failure (SPHF) and postoperative mortality. Methods A retrospective cohort study based on preoperative NT-proBNP measurements in an unselected cohort including all patients undergoing first time surgery for coronary artery disease (CAD; n = 2226), aortic stenosis (AS; n = 406) or mitral regurgitation (MR; n = 346) from April 2010 to August 2016 in the southeast region of Sweden (n = 2978). Concomitant procedures were not included, with the exception of Maze or tricuspid valve procedures. Results Preoperative NT-proBNP was 1.67 times (p<0.0001) and 1.41 times (p<0.0001) higher in patients with AS or MR respectively, than in patients with CAD after adjusting for confounders. NT-proBNP demonstrated significant discrimination with regard to SPHF in CAD (AUC = 0.79, 95%CI 0.73–0.85, p<0.0001), MR (AUC = 0.80, 95%CI 0.72–0.87, p<0.0001) and AS (AUC = 0.66, 95%CI 0.51–0.81, p = 0.047). In CAD patients NT-proBNP demonstrated significant discrimination with regard to postoperative 30-day or in-hospital mortality (AUC = 0.78; 95%CI 0.71–0.85, p<0.0001). The number of deaths was too few in the AS and MR group to permit analysis. Elevated NT-proBNP emerged as an independent risk factor for SPHF, and postoperative mortality in CAD. Conclusions Patients with AS or MR have higher preoperative NT-proBNP than CAD patients even after adjusting for confounders. The predictive value of NT-proBNP with regard to SPHF was confirmed in CAD and MR patients but was less convincing in AS patients.
Collapse
|
14
|
Giordano R, Cantinotti M, Di Tommaso L, Palma G. Surgical strategy for tetralogy of Fallot with abnormal coronary arteries. J Thorac Dis 2017; 9:3447-3449. [PMID: 29268311 DOI: 10.21037/jtd.2017.09.113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Raffaele Giordano
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Luigi Di Tommaso
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Gaetano Palma
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| |
Collapse
|
15
|
Cantinotti M, Giordano R, Scalese M, Molinaro S, Storti S, Murzi B, Pak V, Poli V, Iervasi G, Clerico A. Diagnostic accuracy and prognostic valued of plasmatic Cystatin-C in children undergoing pediatric cardiac surgery. Clin Chim Acta 2017; 471:113-118. [DOI: 10.1016/j.cca.2017.05.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/22/2017] [Accepted: 05/25/2017] [Indexed: 12/18/2022]
|
16
|
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]
|
17
|
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]
|
18
|
Cantinotti M, Clerico A. Brain natriuretic peptide and N-terminal pro-brain natriuretic peptide confirmed the prognostic accuracy in pediatric cardiac surgery: Time for their inclusion in prediction risk models? J Thorac Cardiovasc Surg 2017; 154:641-643. [PMID: 28433357 DOI: 10.1016/j.jtcvs.2017.03.022] [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: 02/14/2017] [Revised: 02/28/2017] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Massa, Italy; Institute of Clinical Physiology, Pisa, Italy.
| | - Aldo Clerico
- Fondazione G. Monasterio CNR-Regione Toscana, Massa, Italy; St'Anna University, Pisa, Italy
| |
Collapse
|
19
|
Fernandes BA, Maher KO, Deshpande SR. Cardiac biomarkers in pediatric heart disease: A state of art review. World J Cardiol 2016; 8:719-727. [PMID: 28070239 PMCID: PMC5183971 DOI: 10.4330/wjc.v8.i12.719] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/27/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
Abstract
Every year there are more than 11000 hospitalizations related to heart failure in children resulting in significant morbidity and mortality. Over the last two decades, our understanding, diagnosis and management of pediatric heart failure is evolving but our ability to prognosticate outcomes in pediatric heart acute heart failure is extremely limited due to lack of data. In adult heart failure patients, the role of cardiac biomarkers has exponentially increased over the last two decades. Current guidelines for management of heart failure emphasize the role of cardiac biomarkers in diagnosis, management and prognostication of heart failure. It is also noteworthy that these biomarkers reflect important biological processes that also open up the possibility of therapeutic targets. There is however, a significant gap present in the pediatric population with regards to biomarkers in pediatric heart failure. Here, we seek to review available data regarding cardiac biomarkers in the pediatric population and also explore some of the emerging biomarkers from adult literature that may be pertinent to pediatric heart failure.
Collapse
|
20
|
Cantinotti M, Valverde I, Kutty S. Three-dimensional printed models in congenital heart disease. Int J Cardiovasc Imaging 2016; 33:137-144. [PMID: 27677762 DOI: 10.1007/s10554-016-0981-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/17/2016] [Indexed: 11/29/2022]
Abstract
The purpose of this article is to discuss technical considerations and current applications of three-dimensional (3D) printing in congenital heart disease (CHD). CHD represent an attractive field for the application of 3D printed models, with consistent progress made in the past decade. Current 3D models are able to reproduce complex cardiac and extra-cardiac anatomy including small details with very limited range of errors (<1 mm), so this tool could be of value in the planning of surgical or percutaneous treatments for selected cases of CHD. However, the steps involved in the building of 3D models, consisting of image acquisition and selection, segmentation, and printing are highly operator dependent. Current 3D models may be rigid or flexible, but unable to reproduce the physiologic variations during the cardiac cycle. Furthermore, high costs and long average segmentation and printing times (18-24 h) limit a more extensive use. There is a need for better standardization of the procedure employed for collection of the images, the segmentation methods and processes, the phase of cardiac cycle used, and in the materials employed for printing. More studies are necessary to evaluate the diagnostic accuracy and cost-effectiveness of 3D printed models in congenital cardiac care.
Collapse
Affiliation(s)
- Massimiliano Cantinotti
- Fondazione Toscana G. Monasterio, Massa, Pisa, Italy.,Institute of Clinical Physiology-CNR, Pisa, Italy
| | - Israel Valverde
- Paediatric Cardiology, Cardio-Thoracic Surgery and Technological Innovation Group, Hospital Virgen del Rocio, Seville, Spain.,Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Hospital Virgen de Rocio/CSIC/University of Seville, Seville, Spain.,Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital, London, UK.,Paediatric Cardiology Unit, Department of Medical Physics, Evelina Children's Hospital, London, UK
| | - Shelby Kutty
- Division of Cardiology, Department of Pediatrics, University of Nebraska Medical Center, Creighton University, Children's Hospital and Medical Center, Omaha, NE, 68198, USA.
| |
Collapse
|
21
|
Caselli C, Cangemi G, Masotti S, Ragusa R, Gennai I, Del Ry S, Prontera C, Clerico A. Plasma cardiac troponin I concentrations in healthy neonates, children and adolescents measured with a high sensitive immunoassay method. Clin Chim Acta 2016; 458:68-71. [DOI: 10.1016/j.cca.2016.04.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 04/22/2016] [Indexed: 10/21/2022]
|
22
|
Cantinotti M. B-Type Cardiac Natriuretic Peptides in the Neonatal and Pediatric Intensive Care Units. J Pediatr Intensive Care 2016; 5:189-197. [PMID: 31110904 DOI: 10.1055/s-0036-1583543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 11/11/2015] [Indexed: 01/29/2023] Open
Abstract
During the last decade, interest in the brain natriuretic peptide (BNP) and N-terminal probrain natriuretic peptide (NT-proBNP) in the pediatric population has progressively increased. The aim of this article is to provide an up to date review of evidences regarding the use of BNP/NT-proBNP in pediatrics, with a particular focus on neonatal intensive care and congenital heart disease. The potentialities of the BNP have been demonstrated in multiple settings, particularly: the screening of congenital/acquired heart disease (CHD) versus pulmonary disease; the evaluation of CHD severity (grade of heart failure, degree of left-to-right shunts); the management of children undergoing cardiac surgery; and monitoring premature infants with patent arterial duct. BNP/NT-proBNP values may be considered an easy and relatively low cost additional diagnostic and prognostic tool. Interpretation of BNP values in children requires attention to important factors, including: laboratory methods, the type of cardiac defect, its severity, and the presence of extracardiac conditions. Of these, the hemodynamic characteristic of CHD and physiologic variations of BNP values occurring during the first weeks of life play a major role. The current evidences in favor of BNP use are mainly derived from single-center, nonrandomized studies, and cost-effectiveness analysis are still lacking. As such, despite sufficient evidences supporting the diagnostic and prognostic potentialities of BNP, these findings should be reinforced by multicenter, randomized studies specifically designed to evaluate outcomes and cost-effectiveness. In addition, standard consensus documents/guidelines, that are currently lacking, are warranted for a more systematic use of BNP in the pediatric age.
Collapse
Affiliation(s)
- Massimiliano Cantinotti
- Fondazione Toscana G. Monasterio, Massa, Pisa, Italy.,Insititute of Clinical Physiology, IFC_CNR, Pisa, Italy
| |
Collapse
|