title: Cardiac Biomarkers of Low Cardiac Output Syndrome in the Postoperative Period After Congenital Heart Disease Surgery in Children.
abstract: OBJECTIVE
  To assess the predictive value of atrial natriuretic peptide, β-type natriuretic peptide, copeptin, mid-regional pro-adrenomedullin (MR-proADM) and cardiac troponin I (cTn-I) as indicators of low cardiac output syndrome in children with congenital heart disease undergoing cardiopulmonary bypass (CPB).
  
  
  METHODS
  After corrective surgery for congenital heart disease under CPB, 117 children (aged 10 days to 180 months) were enrolled in a prospective observational pilot study during a 2-year period. The patients were classified according to whether they developed low cardiac output syndrome. Biomarker levels were measured at 2, 12, 24, and 48 hours post-CPB. The clinical data and outcome variables were analyzed by a multiple logistic regression model.
  
  
  RESULTS
  Thirty-three (29%) patients developed low cardiac output syndrome (group 1) and the remaining 84 (71%) patients were included in group 2. cTn-I levels >14 ng/mL at 2hours after CPB (OR, 4.05; 95%CI, 1.29-12.64; P=.016) and MR-proADM levels>1.5 nmol/L at 24hours following CPB (OR, 15.54; 95%CI, 4.41-54.71; P<.001) were independent predictors of low cardiac output syndrome.
  
  
  CONCLUSIONS
  Our results suggest that cTn-I at 2hours post-CPB is, by itself, an evident independent early predictor of low cardiac output syndrome. This predictive capacity is, moreover, reinforced when cTn-I is combined with MR-proADM levels at 24hours following CPB. These 2 cardiac biomarkers would aid in therapeutic decision-making in clinical practice and would also enable clinicians to modify the type of support to be used in the pediatric intensive care unit.
authors.affiliation: Unidad de Cuidados Intensivos Pediátricos, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Reina Sofía, Córdoba, Spain; Unidad de Investigación Pediátrica, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain. Electronic address: ucip.hrs.sspa@juntadeandalucia.es.
authors.forename: Juan L
authors.initials: JL
authors.lastname: Pérez-Navero
authors.affiliation: Unidad de Investigación Pediátrica, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: de la Torre-Aguilar
authors.affiliation: Unidad de Cuidados Intensivos Pediátricos, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Reina Sofía, Córdoba, Spain; Unidad de Investigación Pediátrica, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ibarra de la Rosa
authors.affiliation: Unidad de Investigación Pediátrica, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Gil-Campos
authors.affiliation: Unidad de Cardiología Pediátrica, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Gómez-Guzmán
authors.affiliation: Unidad de Cirugía Cardiovascular Pediátrica, Unidad de Gestión Clínica de Cirugía Cardiovascular, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Merino-Cejas
authors.affiliation: Unidad de Soporte Metodológico a la Investigación, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.
authors.forename: María C
authors.initials: MC
authors.lastname: Muñoz-Villanueva
authors.affiliation: Unidad de Investigación Pediátrica, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Llorente-Cantarero
mesh_terms: D053607:Adrenomedullin / Q000378:metabolism*; D000704:Analysis of Variance; D015415:Biomarkers / Q000378:metabolism; D002303:Cardiac Output, Low / Q000175:diagnosis*; D002315:Cardiopulmonary Bypass / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D061646:Operative Time; D010446:Peptide Fragments / Q000378:metabolism*; D010865:Pilot Projects; D011183:Postoperative Complications / Q000175:diagnosis*; D011498:Protein Precursors / Q000378:metabolism*; D014336:Troponin / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; D014336:Troponin; C574167:mid-regional pro-adrenomedullin, human; D053607:Adrenomedullin
keywords: Biomarcadores cardiacos; Cardiac biomarkers; Cardiopatía congénita; Children; Congenital heart disease; Niños