title: Atrial natriuretic peptide as a marker of heart failure in children with left ventricular volume overload.
abstract: OBJECTIVE
  To evaluate the role of atrial natriuretic peptide (ANP) in differentiating the aetiology of heart failure in children with left ventricular (LV) volume overload.
  
  
  METHODS
  The study was conducted on 48 patients with LV volume overload (G one: rheumatic heart disease in failure; G2: compensated rheumatic heart disease; G3: congenital left to right shunt; and G4: dilated cardiomyopathy). Twelve healthy children served as a control group. New York Heart Association (NYHA) class, LV dimensions and functions using Vivid 7 dimensions were evaluated. Serum ANP was measured using the ELISA technique, before and 3 months after treatment with angiotensin converting enzyme inhibitor.
  
  
  RESULTS
  ANP was raised in all patients as compared to controls (G one: 28.33 ± 5.78, G2: 26.5 ± 4.11, G3: 28.5 ± 6.6, G4: 29.25 ± 4.5 pg/mL, control group: 5.54 ± 1.4 pg/mL, P < 0.001 for all) and varied significantly between different NYHA classes regardless of the underlying cardiac lesion. It was significantly higher in group 1 than 2 (P < 0.05). It decreased significantly after treatment (G1: 15.3 ± 5.3, G2: 10.7 ± 2.5, G3: 11.5 ± 3.8, G4: 15.7 ± 10.7 pg/mL, P < 0.001). The rate of change of ANP correlated with that of LV end diastolic diameter (r = 0.3, P < 0.05) irrespective of the underlying cause.
  
  
  CONCLUSIONS
  ANP increases in cases of LV volume overload irrespective of the aetiology of heart failure. It can differentiate between children in quiescent state from those in clinical failure even in the absence of echocardiographically detectable systolic dysfunction. Furthermore, it can monitor LV remodelling with treatment.
authors.affiliation: Faculty of Medicine, Department of Pediatric, Ain Shams University, Cairo, Egypt.
authors.forename: Alyaa A
authors.initials: AA
authors.lastname: Kotby
authors.forename: Khaled H
authors.initials: KH
authors.lastname: Taman
authors.forename: Heba Tallah A
authors.initials: HT
authors.lastname: Sedky
authors.forename: Nevin M M
authors.initials: NM
authors.lastname: Habeeb
authors.forename: Eman S
authors.initials: ES
authors.lastname: El-Hadidi
authors.forename: Hanan S
authors.initials: HS
authors.lastname: Yosseif
mesh_terms: D000293:Adolescent; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002311:Cardiomyopathy, Dilated / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000097:blood / Q000150:complications*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D006343:Heart Septal Defects / Q000097:blood / Q000150:complications*; D006349:Heart Valve Diseases / Q000097:blood / Q000150:complications; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D020257:Ventricular Remodeling
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D009320:Atrial Natriuretic Factor