title: NT-proBNP as a marker for persistent cardiac disease in children with history of dilated cardiomyopathy and myocarditis.
abstract: Children with myocarditis and dilated cardiomyopathy may recover clinically and echocardiographically. Plasma levels of the N-terminal segment of B-type natriuretic peptide prohormone (NT-proBNP), a sensitive marker for cardiac dysfunction, may reflect residual cardiac damage in these patients. The purpose of this study was to evaluate NT-proBNP status in pediatric patients with a history of myocarditis and dilated cardiomyopathy. Cardiac evaluation was performed and the levels of NT-proBNP were measured in 23 children who had a history of myocarditis or dilated cardiomyopathy. NT-proBNP levels were also measured in 56 age-matched control children. Nine of the 23 patients had evidence of left ventricular dysfunction (DCM group), whereas 14 had none (recovery). NT-proBNP levels were higher in the DCM group (3154 +/- 2858 pg/ml) than in the recovery group (122 +/- 75 pg/ml, p < 0.001) and the control group (113 +/- 96 pg/ml, p < 0.001). There was no difference between the recovery and the control groups (p = 0.45), and none of the recovered patients had a NT-proBNP level higher than the upper limit of normal. The area under the receiver operating characteristics curve for the diagnosis of persistent left ventricular dysfunction was 0.984. NT-proBNP levels correlated with echocardiographically derived shortening fraction and with clinical score. NT-proBNP is a good marker for persistent left ventricular dysfunction in children who have had myocarditis or cardiomyopathy. In this group of patients, NT-proBNP levels are normal in children who recover echocardiographically, suggesting no residual hemodynamic abnormalities.
authors.affiliation: Hebrew University Medical School, Jerusalem, Israel.
authors.forename: N
authors.initials: N
authors.lastname: Nasser
authors.affiliation: Medical Center, Pediatric Cardiology Unit, Hadassah, Jerusalem, Israel.
authors.forename: Z
authors.initials: Z
authors.lastname: Perles
authors.affiliation: Medical Center, Pediatric Cardiology Unit, Hadassah, Jerusalem, Israel.
authors.forename: A J J T
authors.initials: AJJT
authors.lastname: Rein
authors.affiliation: Shaare Zedek Medical Center, Pediatric Cardiology Unit, Jerusalem, Israel. amiramn@md.huji.ac.il.
authors.forename: A
authors.initials: A
authors.lastname: Nir
mesh_terms: D000293:Adolescent; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002311:Cardiomyopathy, Dilated / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004452:Echocardiography / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D020105:Milrinone / Q000627:therapeutic use; D009205:Myocarditis / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D012016:Reference Values; D013223:Statistics as Topic; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D004077:Digoxin; D020105:Milrinone