Clinical utility of B‐type natriuretic peptide (<scp>NP</scp>) in pediatric cardiac surgery – a systematic review

Afshani, Nura; Schulein, S.; Biccard, Bruce; Thomas, Jenny

doi:10.1111/pan.12467

Cited by 11 publications

(3 citation statements)

References 62 publications

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“…Trending biomarkers such as BNP/NT‐proBNP has increased in the current era, with half of the responding centers now incorporating it into their surveillance protocols. Elevated BNP/NT‐proBNP has been correlated with decreased ventricular function in heart failure . It can serve as a useful screening tool for the presence of ventricular dysfunction in the face of acute rejection, or to support not performing a biopsy in asymptomatic patients with normal non‐invasive imaging .…”

Section: Discussionmentioning

confidence: 99%

Impact of routine surveillance biopsy intensity on the diagnosis of moderate to severe cellular rejection and survival after pediatric heart transplantation

Zinn

Wallendorf

Simpson

et al. 2018

Pediatric Transplantation

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Data are lacking on RSB intensity and outcomes after pediatric heart transplantation. PHTS centers received a survey on RSB practices from 2005 to present. PHTS data were obtained for 2010-2013 and integrated with center-matched survey responses for analysis. Survey response rate was 82.6% (38/46). Centers were classified as low-, moderate-, and high-intensity programs based on RSB frequency (0-more than 8 RSB/y). RSB intensity decreased with increasing time from HT. Age at HT impacted RSB intensity mostly in year 1, with little to no impact in later years. Most centers have not replaced RSB with non-invasive methods, but many added ECHO and biomarker monitoring. Higher RSB intensity was not associated with decreased 4-year mortality (P=.63) or earlier detection of moderate to severe (ISHLT grade 2R/3R) cellular rejection (RSBMSR) in the first year (P=.87). First-year RSBMSR incidence did not differ with intensity or age at HT. Significant variability exists in RSB intensity, but with no impact on timing and incidence of RSBMSR or 4-year mortality. Reduction in RSB frequency may be safe in certain patients after pediatric HT.

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Section: Discussionmentioning

confidence: 99%

Impact of routine surveillance biopsy intensity on the diagnosis of moderate to severe cellular rejection and survival after pediatric heart transplantation

Zinn

Wallendorf

Simpson

et al. 2018

Pediatric Transplantation

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“…Among resultant reviews, a trend can be seen that from 2002 to 2007, pro-BNP was being seriously considered as an important biomarker in acute coronary syndrome and heart failure, as rapid bedside assays became available. [7][8][9][10] After 2007, importance of pro-BNP appeared accepted as illustrated by its inclusion in many therapeutic trials; its role in diverse populations, such as dialysis patients, 11,12 postoperative pediatric patients, 13 atrial fibrillation patients, 14 pediatric septic patients, 15 and pediatric oncology patients, 16 became of interest. There has even been an attempt to use troponin I and NT-pro-BNP to risk stratify emergency room adult patients with palpitations.…”

Section: Literature Reviewmentioning

confidence: 99%

What Is High Enough? Elevated NT-pro-BNP in Decompensated Paroxysmal Supraventricular Tachycardia

Reeves

Womack

Lutherer

et al. 2017

J Pediatr Intensive Care

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Since the late 1980s, elevated atrial natriuretic peptide (ANP) was considered the cause of brisk diuresis in adult patients with paroxysmal supraventricular tachycardia (PSVT). Pro-brain natriuretic peptide (pro-BNP) and related molecules, e.g., N-terminal pro b-type natriuretic peptide (NT-pro-BNP) are known biomarkers of heart failure in adult patients from many causes with probable relevance in children. Perhaps, pro-BNP or related molecules such as NT-pro-BNP are useful in the management of PSVT in infants, thus hastening treatment in children who may otherwise significantly decompensate. Case series of one infant and two neonates presenting with cardiogenic shock and evidence of heart failure are presented. Cardiac monitoring or electrocardiogram (ECG) confirmed the presence of PSVT. Adenosine was administered resulting in successful chemical cardioversion with each case. Significantly elevated NT-pro-BNP levels correlated with heart failure prior to cardioversion. In each case, patients were discharged home with lower NT-pro-BNP levels and maintenance with a β-blocker. Due to documented relationships between elevated pro-BNP level and heart failure in adults, the authors measured the related biomarker NT-pro-BNP in each case, as the relationship could be similar in pediatric PSVT. Based on our experience with children in acute heart failure from other causes, NT-pro-BNP can increase to potentially extreme levels in infants. It appears to correlate with clinical signs of insufficient cardiac output, such as tachycardia, respiratory distress, and moribund appearance. Indeed, in the case series, extremely high NT-pro-BNP values were obtained when the patients appeared moribund from decompensated PSVT. The question arising from these observations is: At what level of elevated NT-pro-BNP, would patients be identified for cardioversion prior to appearance of other signs and symptoms? For each patient within the case series, NT-pro-BNP levels of approximately 20,000 pg/mL were indicative of decompensated heart failure, which was subsequently confirmed by examination of the patient. Further investigation is needed to determine the clinical significance of NT-pro-BNP and related peptides in pediatric patients with PSVT and intermittent PSVT. However, the possibility exists that an increase in NT-pro-BNP and related peptides could be a biomarker for cardiac decompensation after prolonged or intermittent PSVT, thereby shortening the time of diagnosis and intervention, and hence, potentially preventing morbidity, mortality, and extended hospitalization. Additional evidence-based research would help provide biomarker information during PSVT allowing practitioners to more objectively analyze risks.

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“…With the application of NT-proBNP in the diagnosis and management of pediatric patients with various CHD phenotypes (6,(12)(13)(14)(15), quite a few studies have focused on the prognostic value of NT-proBNP in CHD patients undergoing cardiac surgery. However, the findings were inconsistent and sometimes conflict (16)(17)(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of N-terminal pro-form B-type natriuretic peptide (NT-proBNP) in patients with congenital heart disease undergoing cardiac surgery: a systematic review and meta-analysis of cohort studies

Gong¹,

Xing²,

Wu³

et al. 2022

Cardiovasc Diagn Ther

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Background: To perform an updated and comprehensive meta-analysis on the prognostic value of N-terminal pro-form B-type natriuretic peptide (NT-proBNP) in patients with congenital heart disease (CHD) undergoing cardiac surgery.Methods: A systematic search was conducted until September 2021 for relevant studies published in PubMed, Web of Science Database and Embase. Based on the average values, NT-proBNP concentrations were classified as high and low levels. The outcomes of interest were mortality, cardiovascular events, and other postoperative outcomes. A random-effects model was used to calculate composite risk estimates and corresponding 95% confidence intervals (CIs). Possible sources of heterogeneity and stability of results were analyzed using subgroup and sensitivity analyses.Results: A total of 32 studies published between 2008 and 2021 involving 7,571 participants were included.Results showed CHD patients at high NT-proBNP levels yielded an increased risk of mortality [risk ratio (RR) =1.14; 95% CI: 1.08-1.20] and cardiovascular events (RR =2.02; 95% CI: 1.26-3.24) compared with those at low NT-proBNP levels. No significant association was found between NT-proBNP and risks for other postoperative outcomes in CHD patients undergoing cardiac surgery (RR =1.73; 95% CI: 0.86-3.47).Significant heterogeneity was detected across studies regarding these risk estimates. Subgroup analysis found heterogeneity in the risk estimate of mortality was explained by geographic region, type of CHD, and assay method of NT-proBNP. Sensitivity analysis supported the robustness of results.Conclusions: Compared with CHD patients at low NT-proBNP levels, CHD patients at high NT-proBNP levels had elevated risks of mortality and cardiovascular events. Further large-scale and wellcontrolled studies are needed to confirm our findings.

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Clinical utility of B‐type natriuretic peptide (NP) in pediatric cardiac surgery – a systematic review

Abstract: NPs provide a simple, noninvasive and complementary tool to echocardiography that can be used to assist clinicians in the assessment and management of pediatric patients with congenital heart disease in the perioperative period.

Cited by 11 publications

References 62 publications

Impact of routine surveillance biopsy intensity on the diagnosis of moderate to severe cellular rejection and survival after pediatric heart transplantation

Impact of routine surveillance biopsy intensity on the diagnosis of moderate to severe cellular rejection and survival after pediatric heart transplantation

What Is High Enough? Elevated NT-pro-BNP in Decompensated Paroxysmal Supraventricular Tachycardia

Prognostic value of N-terminal pro-form B-type natriuretic peptide (NT-proBNP) in patients with congenital heart disease undergoing cardiac surgery: a systematic review and meta-analysis of cohort studies

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