title: Heart failure with preserved ejection fraction in children: hormonal imbalance between aldosterone and brain natriuretic peptide.
abstract: BACKGROUND
  There is no information on heart failure (HF) with preserved ejection fraction (HFpEF, EF >50%) in children.
  
  
  RESULTS
  Through a retrospective review of 3,907 pediatric patients with cardiovascular disease, we examined the characteristics of pediatric HFpEF over a 10-year period. We identified 18 patients with HFpEF (0.5%). They were predominantly young children (1.1±0.9 years, no sex preponderance), who had undergone surgery for congenital heart disease. They also had concentric hypertrophy and diastolic dysfunction with elevated blood pressure. Notably, HFpEF patients had more pronounced elevation of serum aldosterone but less pronounced elevation of plasma brain natriuretic peptide (BNP) than 22 systolic HF patients (SHF, EF ≤50%) (aldosterone: 1,375±1,200 vs. 511±563pg/ml, P<0.05, and BNP: 101±141 vs. 749±818pg/ml, P<0.005). Consequently, the aldosterone/BNP ratio was significantly higher in HFpEF (38±63) than in SHF (1.7±1.9, P<0.05), and an aldosterone/BNP ratio of 10.3 or higher best predicted HFpEF (area under the curve=0.89). The HF mortality rate was significantly lower in the HFpEF than in the SHF cases, and HF symptoms showed amelioration in 61% of patients during the follow-up period of 4.2±2.6 years.
  
  
  CONCLUSIONS
  HFpEF does exist in children. A common pathophysiology underlies childhood and adult HFpEF despite considerable epidemiological and etiological differences. Future controlled studies are warranted to assess the cause-effect relationship between unique hormonal profiles and HFpEF.
authors.affiliation: Department of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Masutani
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Saiki
authors.forename: Clara
authors.initials: C
authors.lastname: Kurishima
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Ishido
authors.forename: Masanori
authors.initials: M
authors.lastname: Tamura
authors.forename: Hideaki
authors.initials: H
authors.lastname: Senzaki
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000450:Aldosterone / Q000097:blood*; D006332:Cardiomegaly / Q000097:blood / Q000401:mortality / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D006333:Heart Failure / Q000097:blood / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012189:Retrospective Studies; D013318:Stroke Volume; D015996:Survival Rate
chemical_list: D020097:Natriuretic Peptide, Brain; D000450:Aldosterone