The clinical utility of brain natriuretic peptide in paediatric left ventricular failure
Great Ormond Street Hospital, London WC1 3NJH, UK
* Corresponding author. Tel: +44 207 4059200, Fax: +44 207 8138440, Email: burchm{at}gosh.nhs.uk
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Abstract |
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Aims: To assess the role of brain natriuretic peptide (BNP) in both the acute and chronic settings in children with left ventricular (LV) failure.
Methods and results: We undertook a retrospective review of all BNP levels taken over a 2-year period in our institution. Minimum follow-up was 90 days. Ninety-two BNP samples from 48 patients were reviewed. Twenty patients (42%) reached the combined endpoint of death, transplantation, or listing for transplantation. Median age was 3 years and 3 months. Mean BNP levels in NYHA or Ross classes I–IV were 29, 239, 744, and 1593 pg/mL, respectively, with significant differences between mean logBNP in classes I–III (P < 0.001). LogBNP levels correlated with fractional shortening (P < 0.001), LVEDd z-score (P < 0.001), and tissue Doppler velocities (P < 0.02). From serial data there was a strong correlation between change in BNP and change in clinical status (F 9.5, P < 0.001). Receiver-operator curve (ROC) demonstrated that BNP > 290 pg/mL predicts poor outcome with sensitivity of 0.80, specificity of 0.87, and likelihood ratio of 6.4 in paediatric patients with chronic LV dysfunction. A separate ROC from acute presentations did not demonstrate superiority of BNP over other assessments.
Conclusion: BNP levels in paediatric heart failure (HF) patients show a strong correlation to both impaired heart function on echocardiogram and clinical status. Serial BNP levels follow the clinical course. In chronic HF, a BNP level of >290 pg/mL is predictive of an adverse outcome.
Key Words: Brain natriuretic peptide • BNP • Heart failure • Dilated cardiomyopathy
Received March 24, 2007; Revised June 26, 2008; Accepted July 21, 2008