title: Serum N-terminal proatrial natriuretic factor in children with congenital heart disease.
abstract: An objective and simple method of establishing and grading heart failure in children is needed. The N-terminal of the atrial natriuretic factor prohormone, called proANF, is stable in vitro, relatively easy to measure and has been demonstrated as a clinically useful marker of heart failure in adults. We measured proANF in 62 children with congenital heart disease and in 62 age-matched controls, in order to examine the relationship of proANF to different clinical and haemodynamic parameters. Echo Doppler cardiography was performed in all children, and 29 also underwent cardiac catheterization. The children were classified for volume and pressure load in each cardiac chamber, for shunt size and for signs of heart failure. In paediatric patients without cardiac or renal disease, median proANF was 384 pmol.l(-1). In children with congenital heart disease, median proANF was 904 (200-5320) pmol.l(-1) (P < 0.001). The three groups with the highest proANF levels were children with documented high atrial pressure (median proANF 1885 pmol.l(-1)), a large left to right shunt (median proANF 1565 pmol.l-(1)) and moderate or severe heart failure (median proANF 1305 pmol.l(-1)). Furthermore, the proANF level correlated negatively with age and glomerular filtration rate. We conclude that elevation of the proANF level is related to atrial pressures, heart failure and a high pulmonary to systemic flow ratio. These findings make proANF a potential new diagnostic tool in heart disease in children.
authors.affiliation: Department of Pediatrics, National Hospital (Rikshospitalet), Oslo, Norway.
authors.forename: H
authors.initials: H
authors.lastname: Holmström
authors.forename: E
authors.initials: E
authors.lastname: Thaulow
authors.forename: O
authors.initials: O
authors.lastname: Stokke
authors.forename: H
authors.initials: H
authors.lastname: Lindberg
authors.forename: C
authors.initials: C
authors.lastname: Hall
mesh_terms: D000293:Adolescent; D000367:Age Factors; D009320:Atrial Natriuretic Factor / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005919:Glomerular Filtration Rate; D006330:Heart Defects, Congenital / Q000097:blood* / Q000175:diagnosis; D006801:Humans; D007223:Infant; D008297:Male; D011498:Protein Precursors / Q000097:blood*; D012189:Retrospective Studies; D012737:Sex Factors
chemical_list: D011498:Protein Precursors; D009320:Atrial Natriuretic Factor