Alkaline Phosphatase: A Biomarker of Cardiac Function in Pediatric Patients

Abstract

Myocardial dysfunction and heart failure are common in pediatric patients with congenital and acquired heart disease. Alkaline phosphatase (AP) has been suggested as a biomarker for myocardial dysfunction after Fontan operation. We hypothesized that pediatric patients with myocardial dysfunction requiring orthotopic heart transplant (OHT) have diminished AP compared to normal. A retrospective review was performed in all patients who underwent OHT at Arkansas Children's Hospital between January 2007 and October 2012. Anatomic diagnoses, therapeutic interventions, and ventricular ejection fraction (EF) were recorded. Z scores for AP levels in the study group were determined by comparing the observed AP levels to age- and gender-matched normative values. T tests were performed to compare the mean AP Z score prior to and after OHT. p values <0.05 were considered statistically significant. During the study period, 124 OHTs were performed. Complete study data were available and analyzed from 71/124 patients (mean age at OHT 3.9 years; 51% female). The mean AP Z score was significantly lower in the study group prior to OHT compared to normal (p < 0.0001). The initiation of ACE inhibitor therapy prior to OHT was associated with a significant increase in AP and the ventricular EF (p < 0.001 for both). Treatment with milrinone was associated with an increase in EF. AP is significantly lower in pediatric patients with myocardial dysfunction prior to OHT compared to normal. AP increases significantly after the initiation of therapies to improve myocardial function. Diminished AP is an indicator of myocardial dysfunction in pediatric patients.

Alkaline phosphatase: a potential biomarker for stroke and implications for treatment

“…Prior clinical studies have explored AP as a diagnostic and prognostic marker to assess stroke risk by correlating indices of AP activity such as: dysfunctional bone metabolism (Barnadas et al 2014;Namba et al, 2017), cardiovascular disease (Webber et al 2010;Kim et al 2017;Makil et al 2017), cancer (Giessen et al 2014;Barnadas et al 2014;Hammerich et al 2017) and periodontitis (Kunjappu et al 2012). More importantly, elevated AP levels in stroke patients have been correlated with stroke severity and hypertension (Pratibha et al 2014;Tan et al 2017).…”