Levels of brain natriuretic peptide in children with right ventricular overload due to congenital cardiac disease

Thomas

S. Mir a1c1, Jan Falkenberg a1, Bernd Friedrich a1, Urda Gottsch

alk a1, Throng Phi Lê a1, Stephanie Laer a2 and Jochen Weil a1

a1 Herzzentrum, Klinik und Poliklinik für Kinderkardiologie, Hamburg,

Germany

a2 Zentrum für Experimentelle Medizin, Institut für Experimentelle

und Klinische Pharmakologie, Universitätsklinikum Hamburg-

Eppendorf, Hamburg, Germany

Article author query

mir ts   [PubMed] [Google Scholar]  

falkenberg j   [PubMed] [Google

Scholar] 

friedrich b   [PubMed] [Google

Scholar] 

gottschalk u   [PubMed] [Google

Scholar] 

le tp   [PubMed] [Google Scholar]  

laer s   [PubMed] [Google Scholar]  

weil j   [PubMed] [Google Scholar]  AbstractObjective: To evaluate the role of the concentration of brain natriuretic peptide in the plasma, and its correlation with haemodynamic right ventricular parameters, in children with overload of the right ventricle due to congenital cardiac disease. Methods: We studied 31 children, with a mean age of 4.8 years, with volume or pressure overload of the right ventricle caused by congenital cardiac disease. Of the patients, 19 had undergone surgical biventricular correction of tetralogy of Fallot, 11 with pulmonary stenosis and 8 with pulmonary atresia, and 12 patients were studied prior to operations, 7 with atrial septal defects and 5 with anomalous pulmonary venous connections. We measured brain natriuretic peptide using Triage®, from Biosite, United States of America. We determined end-diastolic pressures of the right ventricle, and the peak ratio of right to left ventricular pressures, by cardiac catheterization and correlated them with concentrations of brain natriuretic peptide in the plasma. Results: The mean concentrations of brain natriuretic peptide were 87.7, with a range from 5 to 316, picograms per millilitre. Mean end-diastolic pressure in the right ventricle was 5.6, with a range from 2 to 10, millimetres of mercury, and the mean ratio of right to left ventricular pressure was 0.56, with a range from 0.24 to 1.03. There was a positive correlation between the concentrations of brain natriuretic peptide and the ratio of right to left ventricular pressure (r equal to 0.7844, p less than 0.0001) in all patients. These positive correlations remained when the children with tetralogy of Fallot, and those with atrial septal defects or anomalous pulmonary venous connection, were analysed as separate groups. We also found a weak correlation was shown between end-diastolic right ventricular pressure and concentrations of brain natriuretic peptide in the plasma (r equal to 0.5947, p equal to 0.0004). Conclusion: There is a significant correlation between right ventricular haemodynamic parameters and concentrations of brain natriuretic peptide in the plasma of children with right ventricular overload due to different types of congenital cardiac disease. The monitoring of brain natriuretic peptide may provide a non-invasive and safe quantitative follow up of the right ventricular pressure and volume overload in these patients.

Neurohormonal and cytokine fluctuations following transcatheter closure for an atrial septal defect ☆

Aikaterini C. Chamakou a , , , 

Eleni Dede a , 

Antonia Moutafi a , 

Vassileios Thanopoulos b , 

Stavros Chryssanthopoulos a , 

Sophia Loukopoulou b , 

Christos Pitsavos c , 

Christodoulos Stefanadis c , 

Constantinos H. Davos a , , 

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doi:10.1016/j.cyto.2011.10.002

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Abstract

Introduction

Inflammation and neurohormonal activation are considered to be involved in the

development of earlier and/or later complications in congenital heart disease patients, even

after a successful repair of the lesion. It is not yet clarified what is the role of the therapeutic

interventions in the occurrence of such a response and how it could be associated with

possible postoperative complications.

Aim

We sought to assess the inflammatory and neurohormonal response to transcatheter closure

of secundum type atrial septal defects (ASD) over a six-month follow-up period. We also

evaluated the association between the respective markers and catheterization data as well

as echocardiographic measurements.

Methods

Plasma concentrations of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α),

interleukin-10 (IL-10), N-terminal-proatrial natriuretic peptide (NT-proANP) and N-terminal-

probrain natriuretic peptide (NT-proBNP) were assessed and echocardiographic

measurements were performed in twenty-eight patients with atrial septal defect prior to,

and at the first, second and sixth months post transcatheter closure. Thirty-three age-

matched healthy volunteers were also enrolled.

Results

IL-6 plasma levels, although higher preoperatively, [physical logarithm (ln) IL-6: 3.37 ± 0.66

vs 2.92 ± 0.44 pg/ml, p = 0.015], reached control levels postoperatively, at the end of the

third month, whereas TNF-α and IL-10 were not influenced by the procedure. NT-proANP

levels were elevated preoperatively compared to the control group (ln NT-proANP

3.78 ± 0.572 vs 3.48 ± 0.30, p = 0.031), with a further significant increase during the 1st

month (ln NT-proANP 3.78 ± 0.572 vs 4.2 ± 0.42, p = 0.006), following the pattern of the

left atrial volume enlargement, and remained high even 6 months after the procedure .On

the other hand, the initially normal concentrations of NT-proBNP, after a transient significant

increase during the first month postoperatively (ln NT-proBNP 3.56 ± 0.94 vs

4.58 ± 0.91, p < 0.0001) returned to the controls’ levels at the end of the third month.

Preoperative concentrations of NT-proANP positively correlated with NT-proBNP

concentrations and pulmonary to systemic flow ratio (Qp/Qs).

Conclusions

Transcatheter closure could improve, on a mid- term basis, the inflammatory process but

natriuretic peptides’ secretion continues in parallel with left atrial volume increase. Further

follow up is required to determine the long-term progress of the inflammatory and

neurohormonal response to the procedure.

Relationship between Pericardial Fluid B-type Natriuretic Peptide and Ventricular Structure and Function

Li-Ping Chena, 

Tie-Min Weia, 

Le-Xin Wangb, , 

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doi:10.1016/j.arcmed.2006.12.006

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Background

We undertook this study to investigate the levels of pericardial B-type natriuretic peptide

(BNP) and its relationship with ventricular structure and function.

Methods

Pericardial and plasma BNP concentrations were measured in 18 patients with congenital

ventricular septal defect.

Results

The mean level of BNP in the pericardial fluid (324.8 ± 137.3 pg/mL) was higher than the

plasma (20.8 ± 6.1 pg/mL) (p = 0.03). Pericardial BNP was correlated with the plasma BNP

(r = 0.85, p <0.01). A good correlation was also found between the pericardial BNP and left

atrial diameter, left ventricular end-diastolic and end-systolic diameter, left ventricular

ejection fraction, right ventricular diameter and pulmonary artery systolic pressure

(p <0.05).

Conclusions

The levels of BNP in pericardial fluid were higher than in the plasma. Similar to plasma BNP,

pericardial BNP is also related to the ventricular structure and function.

Brain Natriuretic Peptide Levels Before and After Ventricular Septal Defect Repair

Richard D. Mainwaring, MDa, , , 

Carol Parise, PhDb, 

Stanley B. Wright, MDa, 

Andrew L. Juris, MDa,

Robert A. Achtel, MDa, 

Hessam Fallah, MDa

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doi:10.1016/j.athoracsur.2007.07.021

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Background

Brain natriuretic peptide is a relatively recently discovered circulating mediator that has

been correlated with the degree of heart failure in adults. This study evaluated the

preoperative and postoperative brain natriuretic peptide levels in infants and children

undergoing ventricular septal defect repair.

Methods

The study enrolled 18 infants and children (ages 2 months to 15.6 years) scheduled for

surgical repair of their ventricular septal defects. Brain natriuretic peptide levels were drawn

preoperatively and then postoperatively at 1, 24, 48, and 72 hours. The amount of shunt

(the ratio of pulmonary blood flow [Qp]/systemic blood flow [Qs]) through the ventricular

septal defect was determined by saturation levels performed in the catheterization

laboratory or intraoperatively.

Results

The preoperative brain natriuretic peptide levels (pg/mL) averaged 78 ± 57, and the

postoperative levels were 168 ± 241 at 1 hour, 418 ± 330 at 24 hours, 405 ± 364 at 48

hours, and 391 ± 397 at 72 hours. These differences were significant for each postoperative

time point compared with preoperative values. Preoperative brain natriuretic peptide and

the Qp/Qs were significantly correlated (age-adjusted R2 = 0.33,p < 0.001).

Conclusions

Brain natriuretic peptide levels have a close correlation with the physiologic volume load

caused by ventricular septal defects. The preoperative brain natriuretic peptide levels were

also found to be predictive for the postoperative time course of brain natriuretic peptide

level changes. These results suggest that brain natriuretic peptide levels may be a useful

clinical marker in infants and children with ventricular septal defects.

B-Type Natriuretic Peptide and Heart Failure in Patients with Ventricular Septal Defect: A Pilot Study

Michael A. Paul,  Carl L. Backer,  Helen J. Binns,  Constantine Mavroudis,  Catherine L. Webb,  Ram Yogev,  Wayne H. Franklin

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AbstractIn adults without congenital heart disease, B-type natriuretic peptide (BNP) has been shown to be a very sensitive and specific marker of heart failure. The utility of BNP as a marker of clinical heart failure in children with a ventricular septal defect (VSD) has yet to be determined. A prospective, observational study evaluated BNP levels and other measures of heart failure. Eligible patients were <2 years old, scheduled to undergo surgical repair of a VSD, and without other significant structural heart disease. Data collected before and after surgical repair included echocardiographic measurements, electrocardiographic (ECG) findings, Ross score, BNP measurements, and weight gain. A total of 21 patients were enrolled and 14 patients had complete postoperative follow-up data. For patients with complete data, mean BNP decreased by 94 pg/ml (118 pre vs. 24 post; paired t-test, p = 0.041), mean left ventricular end-diastolic dimension z-score decreased by 1.75 (+0.86 vs. −0.89; paired t-test, p = 0.013), mean weight z-score change per month increased by 0.35 (−0.25 vs. +0.10; Wilcoxon test, p = 0.013), and the incidence of biventricular hypertrophy on ECG decreased (46% vs. 0%; McNemar test, p = 0.031). The change in BNP showed a trend toward a negative correlation with weight z-score change per month (r = −0.531, p = 0.075). In conclusion, BNP, along with other measures of heart failure, decreased following VSD repair, and the change in BNP was most closely correlated with improved weight gain.

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Clinical implication of plasma natriuretic peptides in children with ventricular septal defect

1. Kenji Suda1, 

2. Masahiko Matsumura1and

3. Masahiko Matsumoto2

Article first published online: 26 JUN 2003

DOI: 10.1046/j.1442-200X.2003.01716.x

Issue

Pediatrics International

Volume 45 ,   Issue 3 ,   pages 249–254, June 2003

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Keywords:

A-type natriuretic peptide;

B-type natriuretic peptide;

pulmonary artery pressure;

ventricular septal defect

AbstractBackground: There is little information available concerning plasma concentrations of B-type natriuretic

peptide (BNP) in children with a ventricular septal defect. The aim of the present study was to determine

hemodynamic factors that control plasma concentrations of BNP and the clinical implications of BNP compared with

atrial natriuretic peptide (ANP) in children with ventricular septal defect.

Methods: Fifty-nine patients with ventricular septal defect (28 boys and 31 girls) without pulmonary vascular disease

were enrolled. The patients’ ages ranged from 3 months to 13 years (mean 3.1 years). Plasma BNP and ANP were

determined by immunoradiometric assay. Hemodynamic variables derived from cardiac catheterization were

analyzed in terms of correlation with BNP and ANP.

Results: It was found that plasma BNP significantly positively correlated with ANP (ANP = 2.1 × BNP + 25 pg/mL; r=

0.81, P < 0.0001) and BNP never exceeded ANP in the present patient series. Plasma BNP as well as ANP

significantly positively correlated with pulmonary to systemic flow ratio (r = 0.65 and r= 0.59, respectively) and mean

pulmonary artery pressure (r = 0.72 and r= 0.68, respectively). In addition, plasma BNP of ≥20 pg/mL and ANP of

≥50 pg/mL identified children with mean pulmonary artery pressure of ≥20 mmHg with a sensitivity of 82% and 97%,

respectively, and a specificity of 89% and 84%, respectively.

Conclusion: Plasma BNP and ANP reflect pressure and volume loads to the pulmonary artery and right ventricle

and may help to identify children with ventricular septal defect complicated by pulmonary hypertension that demands

early interventi

Paradoxical Relationship Between B-type Natriuretic Peptide and Pulmonary Vascular Resistance in Patients with Ventricular Septal Defect and Concomitant Severe Pulmonary Hypertension

Manatomo Toyono,  Kenji Harada,  Masamichi Tamura,  Mieko Aoki-Okazaki, 

Shunsuke Shimada,  Jun Oyamada,  Goro Takada

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AbstractB-type natriuretic peptide (BNP) reflects volume overload on left ventricle and pulmonary hypertension (PH) in patients with ventricular septal defect (VSD). Pulmonary vascular resistance (PVR) has been reported to correlate positively with BNP in VSD patients with various degrees of PH. We aimed to investigate the relationship between PVR and BNP in VSD patients with severe PH. We examined 24 subjects with VSD concomitant severe PH aged from 2 months to 17 years (median: 4 months). The ratio of pulmonary to systemic pressure (Pp/Ps), the ratio of pulmonary to systemic flow (Qp/Qs), the ratio of pulmonary to systemic resistance (Rp/Rs), and PVR were determined by cardiac catheterization. PVR and Rp/Rs ranged from 1.6 to 15.5 (mean: 5.7 ± 3.9) Wood unit · m2 and 0.1 to 0.8 (mean: 0.4 ± 0.2), respectively. BNP ranged from 5.5 to 69 (mean: 31 ± 19) pg/ml. Negative correlations were observed between BNP and PVR (r = -0.56, p = 0.004) and BNP and Rp/Rs (r = -0.51, p = 0.01). BNP was significantly lower (<10 pg/ml) in VSD patients with Eisenmenger physiology as compared with the others (p = 0.003). We should draw attention to evaluate BNP values in VSD patients with severe PH.

[Diagnostic value of plasma concentration of pro-brain natriuretic peptide in congestive heart failure in pediatric patients with ventricular septal defects].

(PMID:15833183)

Abstract Citations  BioEntities  Related Articles  External Links 

Wu YR, Chen SB, Huang MR, Zhang YQ, Sun K, Chen S

Cardiology Department, Shanghai Children's Medical Center, Shanghai 200127, China.

Zhonghua er ke za Zhi. Chinese Journal of Pediatrics [2005, 43(3):161-164]

Type: Journal Article, English Abstract (lang: chi)

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OBJECTIVE: The value of plasma brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) can reflect cardiac function and therefore can be used for diagnosing congestive heart failure (CHF) and evaluating cardiac function. There are few reports, however, on the value of BNPand NT-proBNP in pediatric cases of congenital heart defect. The aim of this study was to assess the value of plasma NT-proBNP in the diagnosis of CHF and evaluation of cardiac function in pediatric patients with ventricular septal defect (VSD).

METHODS: Fifty-one patients with VSD aged from 2 months to 2 years old (mean 7.9 months) were enrolled. According to the modified Ross Score, the patients were divided into three groups, no CHFgroup (20 patients), mild CHF group (18 patients) and moderate to severe CHF group (13 patients). Fifteen age-matched normal children were used as controls. Plasma NT-proBNP was measured using enzyme immunoassay. All patients had complete echocardiographic study, including measurement of left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic wall stress (LVSEWS), heart rate corrected mean velocity of circumferential fiber shortening (mVcFc), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), and contractility index (Con). The correlation between plasma NT-proBNP level and modified Ross Score and echocardiographic cardiac functional indexes was determined. The sensitivity, specificity and ROC curve of plasma NT-proBNP for diagnosing CHF was studied.

RESULTS: Plasma NT-proBNP was positively correlated with modified Ross Score (r = 0.75, P < 0.01). Plasma NT-proBNP concentration in moderate to severe CHF group (2061 +/- 908) fmol/ml was significantly higher than that of mild CHF group (810 +/- 335) fmol/ml, and Plasma NT-proBNP concentration in mild CHF group was higher than that in no CHF group (309 +/- 68) fmol/ml. 97.14% of normal controls and subjects in no CHF group had their plasma NT-proBNP below 400 fmol/ml. 83.3% of children in mild CHF group had their plasma NT-proBNP between (400-1400) fmol/ml while in moderate and severe CHF group 84.6% of children had their plasma NT-proBNP beyond 1400 fmol/ml. Plasma NT-proBNP was also positively correlated with LVEDVI and LVSEWS. There was no correlation among mVcFc, LVEF, LVFS, Con and plasma NT-proBNP concentration. Using plasma NT-proBNP concentration > or = 400 fmol/ml as cut-point for diagnosing CHF, the sensitivity was 89.3%, the specificity was 91.2%, and the area under the ROC curve was 0.944.

CONCLUSIONS: Plasma NT-proBNP level could be used to assess cardiac function and diagnoseCHF in pediatric patients with VSD.

Diagnostic performance of BNP and NT-ProBNP measurements in children with heart failure based on congenital heart defects and cardiomyopathies

Murat Şahina, , , 

Oytun Portakalb, 

Tevfik Karagöza, 

Gülşen Hasçelikb, 

Süheyla Özkutlua

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doi:10.1016/j.clinbiochem.2010.08.002

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Abstract

Objectives

To test the diagnostic performance of BNP and NT-ProBNP in children with different

hemodynamic dysfunctions. 3

Design and methods

Seventy children who underwent echocardiography and were classified into left and right

ventricle volume and pressure overload (LVvO, LVpO, RVvO, and RVpO, respectively) and

biventricular volume overload (BVvO) were enrolled.

Results

BNP and NT-ProBNP levels in all groups were higher than those in the control group

(p < 0.001, p < 0.001). The increase in peptide levels was strongly correlated with the

severity of heart failure (p < 0.001, p < 0.001). There was no significant difference in

peptide levels in-between LVvO, LVpO, RVvO, RVpO and BVvO groups. Both measurements

were significantly correlated (r = 0.76, p < 0.001) with each other. NT-ProBNP showed a

high sensitivity, whereas BNP showed a high specificity and accuracy. AUCs in ROC-curve

were 0.97 for BNP and 0.96 for NT-ProBNP.

Conclusions

NT-ProBNP may be used in screening of risk groups for cardiac failure because of its' higher

sensitivity, but BNP may be specifically used in monitoring patients with heart failure.