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Relationship of Pro-BNP Levels with Cardiovascular Events in Pediatric Cardiac and Non-cardiac Diseases

Year 2023, Volume: 13 Issue: 3, 549 - 554, 31.05.2023
https://doi.org/10.16899/jcm.1279791

Abstract

Aim We aimed to determine the relationship of Pro-BNP levels, with the diagnosis, clinical, and laboratory parameters in children. In addition, the predictive power of the Pro-BNP levels in determining the cardiovascular events was evaluated.
Patients and methods: This study comprised 829 patients whose levels of Pro-BNP were measured. The data were obtained retrospectively from the hospital records. The relationship of the Pro-BNP level of the patients with the clinical, laboratory, and echocardiographic data was determined. The predictive power of the Pro-BNP and Troponin T levels in determining the development of cardiovascular events was evaluated.
Results: Cardiovascular events developed in 143 patients during the follow-up period. The Pro-BNP levels were observed to be significantly higher (p< 0.001) in the group in which patients developed cardiovascular events. The Pro-BNP levels demonstrated a positive correlation with both Troponin T levels and procalcitonin levels and a strong negative correlation with the age, height, and weight of the patients. The most important predictive factors for determining the development of cardiovascular events were the presence of tachypnea, increased Pro-BNP levels, increased left ventricular end-diastolic diameter, and increased tricuspid regurgitation velocity.
Conclusion: The most important determinants of a cardiovascular event, as revealed in the present study, are the presence of tachypnea, Pro-BNP levels, TR velocity, and the LVEDD z-score of patients. Moreover, the Pro-BNP levels and Troponin levels demonstrate a strong positive correlation. Randomized prospective studies are warranted to improve the efficacy of using Pro-BNP in differentiating cardiac and non-cardiac diseases in children.

References

  • 1- Hauser JA, Demyanets S, Rusai K, et al. Diagnostic performance and reference values of novel biomarkers of pediatric heart failure. Heart. 2016(15);102(20):1633-9. Doi: 10.1136/heartjnl-2016-309460.
  • 2- Caselli C, Ragusa R, Prontera C, et al. Distribution of circulating cardiac biomarkers in healthy children: from birth through adulthood. Biomark Med. 2016;10(4):357-65. Doi: 10.2217/bmm-2015-0044.
  • 3- Iacob D, Butnariu A, Leucuţa DC, et al. Romanian Journal of Internal Medicine Evaluation of NT-proBNP in children with heart failure younger than 3 years old. Rom J Intern Med. 2017;1;55(2):69-74. Doi: 10.1515/rjim-2017-0002.
  • 4- Davis GK, Bamforth F, Sarpal A, et al. B-type natriuretic peptide in pediatrics. Clin Biochem. 2005;39(6):600-5. Doi: 10.106/j.clinbiochem.2005.12.004.
  • 5- Cantinotti M, Walters HL, Crocetti M, et al. BNP in children with congenital cardiac disease is there now sufficient evidence for its routine use. Cardiol Young .2015;25(3):424-37. Doi: 10.1017/S1047951114002133.
  • 6- Şahin M, Portakal O, Karagöz T,et al. Diagnostic performance of BNP and NT-ProBNP measurements in children with heart failure based on congenital heart defects and cardiomyopathies. Clin Biochem. 2010;43(16-17):1278-81. Doi: 10.1016/j.clinbiochem.2010.08.002
  • 7- Cantinotti M, Law Y, Vittorini S, et al. The potential and limitations of plasma BNP measurement in the diagnosis, prognosis, and management of children. Heart Fail Rev. 2014;19(6):727-42. Doi: 10.1007/s10741-014-9422-2.
  • 8- Gangnus T, Burckhardt BB. Potential and limitations of atrial natriuretic peptide as biomarker in pediatric heart failure- a comparative review. Front Pediatr. 2019;29;6:420. Doi: 10.3389/fped.2018.00420.
  • 9- Lin CW, Tang W, Wen F, et al. Diagnostic accuracy of NT-ProBNP for heart failure with sepsis in patients younger than 18 years. PLoS One. 2016;26;11(1): e0147930. Doi: 10.1371/journal.pone.0147930.
  • 10- Kim HS, Choi HJ. N-terminal pro-B-type natriuretic peptide levels in children: comparison in cardiac and non-cardiac diseases. Cardiol Young. 2020;30(4):500-504. Doi: 10.1017/S1047951120000402.
  • 11- Sugimoto M, Kuwata S, Kurishima C, et al. Cardiac biomarkers in children with congenital heart disease. World J Pediatr. 2015;11(4):309-15. Doi: 10.1007/s12519-015-0039-x.
  • 12- Li J, Ning B, Wang Y, et al. The prognostic value of left ventricular systolic function and cardiac biomarkers in pediatric severe sepsis. Medicine (Baltimore) 2018; 98(13): e15070. Doi: 10.1097/MD.0000000000015070.
  • 13- Ross RD. The Ross classification for heart failure in children after 25 years: a review and an age-stratified revision. Pediatr Cardiol.2012; 33(8):1295-300. Doi: 10.1007/s00246-12-0306-8.
  • 14- Cirer-Sastre R, Legaz-Arrese A, Corbi F, et al. Cardiac Biomarker Release After Exercise in Healthy Children and Adolescents: A Systematic Review and Meta-Analysis. Pediatr Exerc Sci. 2019;1;31(1):28-36. Doi: 10.1123/pes.2018-0058.
  • 15- Leerink JM, Verkleij SJ, Feijen EAM, et al. Biomarkers to diagnose ventricular dysfunction in childhood cancer survivors a systematic review. Heart. 2019;105(3):210-216. Doi: 10.1136/heartjnl-2018-313634.
  • 16- Koulouri S, Acherman RJ, Wong PC, et al. Utility of B-type natriuretic peptide in differentiating congestive heart failure from lung disease in pediatric patients with respiratory distress. Pediatr Cardiol 2004;25: 341–6. Doi: 10.1007/s00246-003-0578-0.
  • 17- Cantinotti M, Giovannini S, Murzi B, et al. Diagnostic, prognostic and therapeutic relevance of B-type natriuretic peptide assay in children with congenital heart diseases. Clin Chem Lab Med. 2011;49: 567–580. Doi: 10.1515/CCLM.2011.106.
  • 18- Eindhoven JA, van den Bosch AE, Jansen PR, et al. The usefulness of brain natriuretic peptide in complex congenital heart disease: a systematic review. J Am Coll Cardiol 2012;60: 2140–2149. Doi:10.1016/j.jacc.2012.02.092.
  • 19- Maher KO, Reed H, Cuadrado A, et al. B-type natriuretic peptide in the emergency diagnosis of critical heart disease in children. Pediatrics. 2008;121: e1484–e1488. Doi: 10.1542/peds.2007-1856.
  • 20- Law YM, Hoyer AW, Reller MD, et al. Accuracy of plasma B-type natriuretic peptide to diagnose significant cardiovascular disease in children: the better not pout children! Study. J Am Coll Cardiol 2009;54: 1467–1475. Doi: 10.1016/j.jacc.2009.06.020.
  • 21- Desjardins L, Dionne A, Meloche-Dumas L, et al. Echocardiographic parameters during and beyond onset of Kawasaki disease correlate with onset serum N Terminal pro Brain Natriuretic. Pediatr Cardiol.2020;41(5): 947-954. Doi: 10.1007/s00246-020-02340-z.
  • 22- Michel L, Mincu RI, Mrotzek SM, et al. Cardiac biomarkers for the detection of cardiotoxicity in childhood cancer a meta-analysis. ESC Heart Fail. 2020;7(2):423-433. Doi: 10.1002/ehf2.12589.
  • 23- Butnariu A, Iancu M, Samaşca G,et al. Changes in NT-proBNP in young children with congenital heart malformations. Lab Med. 2014;45(1):43-7. Doi: 10.1309/Imao4uy90yjqwkkp.
  • 24- Cantinotti M, Storti S, Parri MS, et al. Reference intervals for brain natriuretic peptide in healthy newborns and infants measured with an automated immunoassay platform. Clin Chem Lab Med. 2010;48: 697–700. Doi: 10.1515/CCLM.2010.129. 25- Holmgren D, Westerlind A, Berggren H, et al. Increased natriuretic peptide type B level after the second palliative step in children with univentricular hearts with right ventricular morphology but not left ventricular morphology. Pediatr Cardiol.2008;29: 786–792. Doi: 10.1007/s00246-008-9201-8.

Pediyatrik kardiyak ve nonkardiyak hastalıklarda pro- BNP düzeyi ile kardiyovasküler olayların ilişkisi

Year 2023, Volume: 13 Issue: 3, 549 - 554, 31.05.2023
https://doi.org/10.16899/jcm.1279791

Abstract

Amaç: Bu çalışmada amacımız Pro- BNP düzeyi ile hastaların tanıları, klinik ve laboratuvar bulguları arasındaki ilişkiyi değerlendirmektir. Ayrıca pro-BNP düzeyinin kardiyovasküler olay belirlemedeki öngörü düzeyini değerlendirmeyi amaçladık.
Hastalar ve metod: Bu çalışmada, Pro-BNP düzeyi bakılmış olan 829 hastanın verileri elektronik dosya kayıtlarından retrospektif olarak elde edildi. Pro-BNP düzeyi ile hastaların klinik, laboratuvar ve ekokardiyografik verileri rasındaki ilişki değerlendirildi. Ayrıca Pro- BNP ve troponin T düzeylerinin kardiyovasküler olayları belirleyiciliği değerlendirildi.
Sonuçlar: Takip süresi oyunca 143 hastada kardiyovasküler olay gelişti. Pro-BNP seviyesi bu hasta grubunda anlamlı yüksekti (p< 0,001). Pro- BNP düzeyi ile troponin T, prokalsitonin düzeyi ile pozitif, yaş, boy ve vücut ağırlığı ile güçlü negatif korelasyon mevcuttu. Kardiyovasküler olay belirlemede en güçlü prediktörler takipne, artmış Pro- BNP, artmış triküspit kapak velositesi ve artmış sol ventrikül end-diyastolik çapı idi.
Sonuç: Bu çalışmada kardiyovasküler olay belirlemede en güçlü belirleyiciler takipne, Pro-BNP düzeyi, triküspit yetersizlik velositesi ve sol ventrikül end-diyastolik çapı Z skoru idi. Ayrıca pro-BNP ve Troponin T düzeyleri arasında güçlü pozitif korelasyon mevcuttu. Çocuklarda kardiyak ve nonkardiyak hastalıkların ayırımında pro-BNP düzeyi belirleyiciliği düşük bulunmuş olup, randomize prospektif kontrollü çalışmalara ihtiyaç vardır.

References

  • 1- Hauser JA, Demyanets S, Rusai K, et al. Diagnostic performance and reference values of novel biomarkers of pediatric heart failure. Heart. 2016(15);102(20):1633-9. Doi: 10.1136/heartjnl-2016-309460.
  • 2- Caselli C, Ragusa R, Prontera C, et al. Distribution of circulating cardiac biomarkers in healthy children: from birth through adulthood. Biomark Med. 2016;10(4):357-65. Doi: 10.2217/bmm-2015-0044.
  • 3- Iacob D, Butnariu A, Leucuţa DC, et al. Romanian Journal of Internal Medicine Evaluation of NT-proBNP in children with heart failure younger than 3 years old. Rom J Intern Med. 2017;1;55(2):69-74. Doi: 10.1515/rjim-2017-0002.
  • 4- Davis GK, Bamforth F, Sarpal A, et al. B-type natriuretic peptide in pediatrics. Clin Biochem. 2005;39(6):600-5. Doi: 10.106/j.clinbiochem.2005.12.004.
  • 5- Cantinotti M, Walters HL, Crocetti M, et al. BNP in children with congenital cardiac disease is there now sufficient evidence for its routine use. Cardiol Young .2015;25(3):424-37. Doi: 10.1017/S1047951114002133.
  • 6- Şahin M, Portakal O, Karagöz T,et al. Diagnostic performance of BNP and NT-ProBNP measurements in children with heart failure based on congenital heart defects and cardiomyopathies. Clin Biochem. 2010;43(16-17):1278-81. Doi: 10.1016/j.clinbiochem.2010.08.002
  • 7- Cantinotti M, Law Y, Vittorini S, et al. The potential and limitations of plasma BNP measurement in the diagnosis, prognosis, and management of children. Heart Fail Rev. 2014;19(6):727-42. Doi: 10.1007/s10741-014-9422-2.
  • 8- Gangnus T, Burckhardt BB. Potential and limitations of atrial natriuretic peptide as biomarker in pediatric heart failure- a comparative review. Front Pediatr. 2019;29;6:420. Doi: 10.3389/fped.2018.00420.
  • 9- Lin CW, Tang W, Wen F, et al. Diagnostic accuracy of NT-ProBNP for heart failure with sepsis in patients younger than 18 years. PLoS One. 2016;26;11(1): e0147930. Doi: 10.1371/journal.pone.0147930.
  • 10- Kim HS, Choi HJ. N-terminal pro-B-type natriuretic peptide levels in children: comparison in cardiac and non-cardiac diseases. Cardiol Young. 2020;30(4):500-504. Doi: 10.1017/S1047951120000402.
  • 11- Sugimoto M, Kuwata S, Kurishima C, et al. Cardiac biomarkers in children with congenital heart disease. World J Pediatr. 2015;11(4):309-15. Doi: 10.1007/s12519-015-0039-x.
  • 12- Li J, Ning B, Wang Y, et al. The prognostic value of left ventricular systolic function and cardiac biomarkers in pediatric severe sepsis. Medicine (Baltimore) 2018; 98(13): e15070. Doi: 10.1097/MD.0000000000015070.
  • 13- Ross RD. The Ross classification for heart failure in children after 25 years: a review and an age-stratified revision. Pediatr Cardiol.2012; 33(8):1295-300. Doi: 10.1007/s00246-12-0306-8.
  • 14- Cirer-Sastre R, Legaz-Arrese A, Corbi F, et al. Cardiac Biomarker Release After Exercise in Healthy Children and Adolescents: A Systematic Review and Meta-Analysis. Pediatr Exerc Sci. 2019;1;31(1):28-36. Doi: 10.1123/pes.2018-0058.
  • 15- Leerink JM, Verkleij SJ, Feijen EAM, et al. Biomarkers to diagnose ventricular dysfunction in childhood cancer survivors a systematic review. Heart. 2019;105(3):210-216. Doi: 10.1136/heartjnl-2018-313634.
  • 16- Koulouri S, Acherman RJ, Wong PC, et al. Utility of B-type natriuretic peptide in differentiating congestive heart failure from lung disease in pediatric patients with respiratory distress. Pediatr Cardiol 2004;25: 341–6. Doi: 10.1007/s00246-003-0578-0.
  • 17- Cantinotti M, Giovannini S, Murzi B, et al. Diagnostic, prognostic and therapeutic relevance of B-type natriuretic peptide assay in children with congenital heart diseases. Clin Chem Lab Med. 2011;49: 567–580. Doi: 10.1515/CCLM.2011.106.
  • 18- Eindhoven JA, van den Bosch AE, Jansen PR, et al. The usefulness of brain natriuretic peptide in complex congenital heart disease: a systematic review. J Am Coll Cardiol 2012;60: 2140–2149. Doi:10.1016/j.jacc.2012.02.092.
  • 19- Maher KO, Reed H, Cuadrado A, et al. B-type natriuretic peptide in the emergency diagnosis of critical heart disease in children. Pediatrics. 2008;121: e1484–e1488. Doi: 10.1542/peds.2007-1856.
  • 20- Law YM, Hoyer AW, Reller MD, et al. Accuracy of plasma B-type natriuretic peptide to diagnose significant cardiovascular disease in children: the better not pout children! Study. J Am Coll Cardiol 2009;54: 1467–1475. Doi: 10.1016/j.jacc.2009.06.020.
  • 21- Desjardins L, Dionne A, Meloche-Dumas L, et al. Echocardiographic parameters during and beyond onset of Kawasaki disease correlate with onset serum N Terminal pro Brain Natriuretic. Pediatr Cardiol.2020;41(5): 947-954. Doi: 10.1007/s00246-020-02340-z.
  • 22- Michel L, Mincu RI, Mrotzek SM, et al. Cardiac biomarkers for the detection of cardiotoxicity in childhood cancer a meta-analysis. ESC Heart Fail. 2020;7(2):423-433. Doi: 10.1002/ehf2.12589.
  • 23- Butnariu A, Iancu M, Samaşca G,et al. Changes in NT-proBNP in young children with congenital heart malformations. Lab Med. 2014;45(1):43-7. Doi: 10.1309/Imao4uy90yjqwkkp.
  • 24- Cantinotti M, Storti S, Parri MS, et al. Reference intervals for brain natriuretic peptide in healthy newborns and infants measured with an automated immunoassay platform. Clin Chem Lab Med. 2010;48: 697–700. Doi: 10.1515/CCLM.2010.129. 25- Holmgren D, Westerlind A, Berggren H, et al. Increased natriuretic peptide type B level after the second palliative step in children with univentricular hearts with right ventricular morphology but not left ventricular morphology. Pediatr Cardiol.2008;29: 786–792. Doi: 10.1007/s00246-008-9201-8.
There are 24 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Research
Authors

Ayşe Sülü 0000-0001-6384-3935

Hikmet Kıztanır 0000-0001-8422-4113

Pelin Kosger 0000-0002-3926-9002

Birsen Ucar 0000-0002-7746-6058

Publication Date May 31, 2023
Acceptance Date May 15, 2023
Published in Issue Year 2023 Volume: 13 Issue: 3

Cite

AMA Sülü A, Kıztanır H, Kosger P, Ucar B. Relationship of Pro-BNP Levels with Cardiovascular Events in Pediatric Cardiac and Non-cardiac Diseases. J Contemp Med. May 2023;13(3):549-554. doi:10.16899/jcm.1279791