Correlation of Plasma B-Type Natriuretic Peptide with Shunt Severity in Patients with Atrial or Ventricular Septal Defect

Abstract

The goal of this study was to test the utility of bedside plasma concentration of B-type natriuretic peptide (BNP) assay as a screen for large shunts in pediatric patients with atrial septal defects (ASDs) and ventricular septal defects (VSDs). Thirty-five children at a mean age of 70+/-129 weeks with ASD or VSD were included in the study. Nine patients had VSD and 26 had ASD. Plasma BNP values were compared with the Qp/Qs ratios derived from quantitative Doppler flow measurements. Mean BNP was 29+/-42 pg/ml, with a range between<5 pg/ml and 208 pg/ml. Sixteen patients had Qp/Qs values>1.5 and 19 had values<1.5. The difference of mean BNP in these patient groups was statistically significant (45+/-56 vs 14+/-17, p=0.03). BNP was positively correlated with shunt significance. Receiver operating characteristic curve analysis revealed a sensitivity of 69% and a specificity of 79% at a plasma BNP cut-off level of>or=20 pg/ml. Bedside measurement of BNP correlates with magnitude of ASD and VSD in children. BNP can provide information for the management of children with ASD or VSD. It can be used as part of the evaluation of a child with a preliminary diagnosis of a congenital defect.

Cardiac biomarkers in children with congenital heart disease

“…In heart disease due to a left-to-right shunt, such as ASDs and VSDs, NT-proBNP levels are high when the Qp/Qs is high, and the fact that this decreases after surgery indicates that congestive HF due to volume overload may result in increased NT-proBNP levels. [41][42][43] Moreover, right ventricular volume overload due to pulmonary regurgitation after surgery for TOF also leads to increased NT-proBNP levels. [44,45] NT-proBNP levels have been reported as a useful marker of HF in patients with single ventricular circulation after Fontan surgery.…”

Rotura extensa de septo interventricular por traumatismo torácico cerrado

“…Sin embargo, hasta el momento actual no se ha descrito el comportamiento del péptido natriurético en la patología traumática cardíaca, por lo que, al tratarse de pacientes jóvenes y sin cardiopatía previa, podría estar razonablemente justificada su determinación. Sí están descritos casos que correlacionan valores de proBNP con la gravedad del shunt izquierda-derecha, PAP y dilatación de cavidades derechas en pacientes adultos y pediátricos con defectos septal auricular o ventricular no traumáticos 17,18 .…”

B-Type Natriuretic Peptide (BNP) in Neonates, Infants and Children Undergoing Cardiac Surgery

“…Ozhan and colleagues found the same relationship between BNP and the Qp:Qs ratio in their study of 35 children (mean age 70±129 weeks) with ventricular or atrial septal defects. Receiver operating characteristic analysis found that a plasma BNP cutoff of ≥20 pg/ml was 69% sensitive and 79% specific for a Qp:Qs of greater than 1.5 (Ozhan et al 2007). A number of studies of premature neonates found that BNP levels correlated with the degree of shunting across a patent ductus arteriosus and predicted hemodynamic significance as determined by echocardiography-based criteria (Choi et al 2005;Flynn et al 2005;Puddy et al 2002;Sanjeev et al 2005;Holmstrom and Omland 2002;da Graca et al 2006).…”