title: N-terminal pro-brain natriuretic peptide in acute Kawasaki disease correlates with coronary artery involvement.
abstract: BACKGROUND
  We have lately documented the importance of N-terminal pro-brain natriuretic peptide in aiding the diagnosis of Kawasaki disease.
  
  
  OBJECTIVE
  We sought to investigate the potential value of N-terminal pro-brain natriuretic peptide pertaining to the prediction of coronary artery dilatation (Z-score>2.5) and/or of resistance to intravenous immunoglobulin therapy. We hypothesised that increased serum N-terminal pro-brain natriuretic peptide level correlates with increased coronary artery dilatation and/or resistance to intravenous immunoglobulin.
  
  
  METHODS
  We carried out a prospective study involving newly diagnosed patients treated with 2 g/kg intravenous immunoglobulin within 5-10 days of onset of fever. Echocardiography was performed in all patients at onset, then weekly for 3 weeks, then at month 2, and month 3. Coronary arteries were measured at each visit, and coronary artery Z-score was calculated. All the patients had N-terminal pro-brain natriuretic peptide serum level measured at onset, and the Z-score calculated.
  
  
  RESULTS
  There were 109 patients enrolled at 6.58±2.82 days of fever, age 3.79±2.92 years. High N-terminal pro-brain natriuretic peptide level was associated with coronary artery dilatation at onset in 22.2 versus 5.6% for normal N-terminal pro-brain natriuretic peptide levels (odds ratio 4.8 [95% confidence interval 1.05-22.4]; p=0.031). This was predictive of cumulative coronary artery dilatation for the first 3 months (p=0.04-0.02), but not during convalescence at 2-3 months (odds ratio 1.28 [95% confidence interval 0.23-7.3]; p=non-significant). Elevated N-terminal pro-brain natriuretic peptide levels did not predict intravenous immunoglobulin resistance, 15.3 versus 13.5% (p=1).
  
  
  CONCLUSIONS
  Elevated N-terminal pro-brain natriuretic peptide level correlates with acute coronary artery dilatation in treated Kawasaki disease, but not with intravenous immunoglobulin resistance.
authors.affiliation: 1Division of Pediatric Cardiology,Department of Pediatrics,Centre Hospitalier Universitaire Sainte-Justine,Université de Montréal,Montréal,Quebec,Canada.
authors.forename: Philippe M
authors.initials: PM
authors.lastname: Adjagba
authors.affiliation: 1Division of Pediatric Cardiology,Department of Pediatrics,Centre Hospitalier Universitaire Sainte-Justine,Université de Montréal,Montréal,Quebec,Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Desjardins
authors.affiliation: 1Division of Pediatric Cardiology,Department of Pediatrics,Centre Hospitalier Universitaire Sainte-Justine,Université de Montréal,Montréal,Quebec,Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Fournier
authors.affiliation: 4Department of Pediatrics,Maisonneuve Rosemont Hospital,Montréal,Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Spigelblatt
authors.affiliation: 5Department of Cardiology,Cité-de-la-Santé Hospital,Laval,Quebec,Canada.
authors.forename: Martine
authors.initials: M
authors.lastname: Montigny
authors.affiliation: 1Division of Pediatric Cardiology,Department of Pediatrics,Centre Hospitalier Universitaire Sainte-Justine,Université de Montréal,Montréal,Quebec,Canada.
authors.forename: Nagib
authors.initials: N
authors.lastname: Dahdah
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004452:Echocardiography; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000175:diagnosis* / Q000188:drug therapy*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D016756:Immunoglobulins, Intravenous; D020097:Natriuretic Peptide, Brain
keywords: Kawasaki disease; N-terminal pro-brain natriuretic peptide; coronary artery involvement; prediction; predictive value