Usefulness of B-Type Natriuretic Peptide and N-Terminal Pro-B-Type Natriuretic Peptide as Biomarkers for Heart Failure in Young Children With Single Ventricle Congenital Heart Disease

Study Questions:

Do B-type natriuretic peptide (BNP) levels correlate with heart failure (HF) in patients with single-ventricle (SV) physiology?

Methods:

This was a single-center cross-sectional observational study of n = 71 children (1 month-7 years) with SV physiology. A Ross score (comprised of physical exam findings, feeding history, and vitals) >2 was used to define clinical HF. The primary outcome of interest was HF based on BNP and N-terminal pro-BNP (NT-proBNP) levels.

Results:

Clinical HF occurred in 31% (n = 22) of the 71 children with a SV. Children with clinical HF had a mean Ross score of 4 ± 17, whereas those without HF had scores of 1 ± 0.8. A doubling of BNP (odds ratio [95% confidence interval] 2.2 [1.4-3.6]) and/or pro-NT-BNP (odds ratio 1.92 [1.2-3.1]) was associated with an increased odds of clinical HF when the stage of repair was held constant. Using a BNP threshold of ≥45 pg/ml, the sensitivity and specificity for HF was 62% and 81%, respectively. Accuracy appeared to be higher at higher stages of surgical repair. Using a NT-proBNP threshold of ≥1100 pg/ml, the sensitivity and specificity was 78% and 83%, respectively. When stratifying by stage of repair, lower NT-proBNP thresholds led to better CHF risk discrimination (stage 1 = 1900 mg/ml; stage 2 = 1100 pg/ml; stage II = 300 pg/ml).

Conclusions:

Regardless of the stage of palliation, BNP and NT-proBNP are useful tests for clinical HF in children with SV physiology.

Perspective:

This study demonstrates that BNP and NT-proBNP levels correlate with clinical HF, as defined by a Ross score. The authors suggest that BNP and NT-proBNP may be useful in guiding timing of surgical interventions in patients with SV. The accuracy of the Ross score in predicting HF in the right ventricle SV population is unknown. This limitation aside, if a decline in BNP and NT-proBNP is demonstrated following repair, and such information leads to better outcome, testing may be useful in risk stratification of these patients.

Clinical Topics: Anticoagulation Management, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Congenital Heart Disease, CHD and Pediatrics and Quality Improvement, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Odds Ratio, Heart Defects, Congenital, Cross-Sectional Studies, Sensitivity and Specificity, Nerve Tissue Proteins, Heart Diseases, Biological Markers, Heart Failure, Peptide Fragments, Confidence Intervals, Heart Ventricles, Thiazolidinediones, Natriuretic Peptide, Brain


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