Clinical and functional characterisation of rheumatic mitral regurgitation in children and adolescents including the brain natriuretic peptide

Abstract

Rheumatic fever is a public health problem of universal distribution, predominantly affecting individuals in developing countries. In individuals less than 20 years of age, pure mitral regurgitation is the most commonly found condition in chronic rheumatic valve disease. In the present study, rheumatic mitral regurgitation was assessed in children and adolescents, addressing its clinical (duration of the disease, symptoms, use of benzathine penicillin, and number of outbreaks of the acute phase of rheumatic fever), electrocardiographic (left atrium abnormality and/or left ventricle hypertrophy) and echocardiographic characteristics (left atrium and ventricle measurements, ejection fraction and pulmonary artery pressure), as well as plasma dose of N-terminal portion of the brain natriuretic peptide through electrochemiluminescence immunoassay. Fifty-three patients were studied. The patients had moderate (41.5%) or severe (58.5%) rheumatic mitral regurgitation; had not undergone surgery; were not in the acute phase of the disease; and were being treated at a paediatric cardiology reference hospital in Northeastern Brazil. Mean patient age was 10.6 years (minimum of 3 and maximum of 19 years). With the exception of the ejection fraction, the echocardiographic variables had a significant correlation to the natriuretic peptide, demonstrating that this hormone reflects the haemodynamic consequences of mitral regurgitation. It was concluded that cardiac remodelling that occurs in rheumatic mitral regurgitation in children and adolescents leads to the production of the brain natriuretic peptide, which could be used as a complementary diagnostic tool in the follow-up of such patients.

Mitral Regurgitation and Serum N-Terminal Pro-Brain Natriuretic Peptide Levels in Children: A Modification of Adult Criteria

“…After MV replacement, decline in NT-proBNP levels correlated with improvement in NYHA classification and EF and reduction in LAD and LVESD. 21 In concordance with findings by Ribiero and associates, 15 we found that NT-proBNP level correlated with LAD/BSA and LVESD/BSA, highlighting the hemodynamic consequences of MR. Heart failure symptoms in pediatric patients after the infant and toddler periods may be subtle. This emphasizes the need for the measurement of reliable parameters in the follow-up monitoring of these patients.…”

“…[12][13][14] To our knowledge, only one study has evaluated NT-proBNP levels in children with rheumatic valvular heart disease. 15 In that study, the median NT-proBNP level was 154.4 pg/mL in children with moderate MR and 220.3 pg/mL in children with severe MR. This suggests that the lower NT-proBNP results in our study may be related to the higher proportion of patients with moderate MR to patients with severe MR.…”

The relationship between echocardiographic parameters and brain natriuretic peptide levels in acute and chronic mitral regurgitation

“…A recent study involving children and adolescents found significant correlations between N-terminal pro-BNP and echocardiographic indices of MR. [29] The correlations were significant and strong with the dimension and volume of the left atrium, and EDD and ESD of the LV, indexed for body surface area.…”