Biomarker responses during mid-term mechanical cardiac support in children.
BACKGROUND
The purpose of this study was to determine the effect of mid-term mechanical circulatory support on the natriuretic hormone system in children and to assess whether such changes are associated with myocardial recovery.


METHODS
Serial blood samples were collected from 19 children (median age 10.8 years, range 0.2 to 17.5 years), all supported with a pulsatile ventricular assist device (Berlin Heart EXCOR; median support time 55 days). Levels of NT-proBNP were analyzed before and 7 and 30 days after device implantation. In addition, we determined levels of mid-region proANP (MR-proANP) and BNP in 13 of the 19 children.


RESULTS
The actuarial survival rate to discharge home was 84%. Two children could be weaned from the system, 14 reached heart transplantation, and 3 died during mechanical circulatory support. Serial measurements of NT-proBNP, BNP and MR-proANP showed a significant down-regulation of all three natriuretic peptides within the first week of support and a further decrease between Days 7 and 30. The lowest NT-proBNP level while on the device (250 pg/ml) was found in the child later weaned, who reached normal levels (71 pg/ml) within 12 weeks after weaning.


CONCLUSIONS
Extremely high levels of natriuretic peptides reflect the severity of myocardial failure before device implantation. During mechanical support, the decline of natriuretic peptides appears to be a helpful additional tool in the pre-selection of potential weaning candidates.
Heise
Grit
G
Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany. heise@dhzb.de
Lemmer
Julia
J
Weng
Yuguo
Y
Hübler
Michael
M
Alexi-Meskishvili
Vladimir
V
Böttcher
Wolfgang
W
Hetzer
Roland
R
Berger
Felix
F
Stiller
Brigitte
B
D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004868:Equipment Failure; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000401:mortality* / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011336:Probability; D011379:Prognosis; D012016:Reference Values; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014850:Waiting Lists
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain