B-type natriuretic peptide and heart failure in patients with ventricular septal defect: a pilot study.
In adults without congenital heart disease, B-type natriuretic peptide (BNP) has been shown to be a very sensitive and specific marker of heart failure. The utility of BNP as a marker of clinical heart failure in children with a ventricular septal defect (VSD) has yet to be determined. A prospective, observational study evaluated BNP levels and other measures of heart failure. Eligible patients were <2 years old, scheduled to undergo surgical repair of a VSD, and without other significant structural heart disease. Data collected before and after surgical repair included echocardiographic measurements, electrocardiographic (ECG) findings, Ross score, BNP measurements, and weight gain. A total of 21 patients were enrolled and 14 patients had complete postoperative follow-up data. For patients with complete data, mean BNP decreased by 94 pg/ml (118 pre vs. 24 post; paired t-test, p = 0.041), mean left ventricular end-diastolic dimension z-score decreased by 1.75 (+0.86 vs. -0.89; paired t-test, p = 0.013), mean weight z-score change per month increased by 0.35 (-0.25 vs. +0.10; Wilcoxon test, p = 0.013), and the incidence of biventricular hypertrophy on ECG decreased (46% vs. 0%; McNemar test, p = 0.031). The change in BNP showed a trend toward a negative correlation with weight z-score change per month (r = -0.531, p = 0.075). In conclusion, BNP, along with other measures of heart failure, decreased following VSD repair, and the change in BNP was most closely correlated with improved weight gain.
Paul
Michael A
MA
Department of Pediatrics, Children's Memorial Hospital, Chicago, IL 60614, USA. mpaul@childrensmemorial.org
Backer
Carl L
CL
Binns
Helen J
HJ
Mavroudis
Constantine
C
Webb
Catherine L
CL
Yogev
Ram
R
Franklin
Wayne H
WH
D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D013223:Statistics as Topic; D014463:Ultrasonography; D015430:Weight Gain
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain