N-terminal pro-brain natriuretic peptide and prediction of coronary artery dilatation in hyperacute phase of Kawasaki disease

Jung, Jae Yun; Ham, Eun Mi; Kwon, Hyuksool; Kwak, Young Ho; Kim, Do Kyun; Lee, Jin Hee; Jung, Jin Hee

doi:10.1016/j.ajem.2018.06.021

Cited by 11 publications

(10 citation statements)

References 11 publications

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“…Our results were in agreement with the pervious findings in value of NT-proBNP in predicting the presence of cardiac involvement (20)(21)(22). However, they had limited the definition of cardiac involvement to the development of coronary artery aneurysm but we also assessed the presence of perivascular brightness of coronary arteries as a preceding factor of developing of coronary artery aneurysm or subsequent coronary ectasia (27,28).…”

Section: Discussionsupporting

confidence: 91%

“…Previously the optimum cut-off points for NT-proBNP levels in for diagnosing the coronary artery aneurysm in KD patients were indicated to be at 1000 pg/ml with a sensitivity of 83% and a specificity of 68% by Kaneko et al and to be at 1300 pg/ml with 95% sensitivity and 85% specificity by Yoshimura et al which were both close to the occupied cut-off point in our study (34). However, a very recent study of Jung et al found a lower cut-off point of 515.4 pg/ml with a sensitivity of 78.26% and a specificity of 61.63% (22). The high values of sensitivity and specificity of NT-proBNP at the cutoff point of 1354 pg/ml in our study could be due to the evaluation of perivascular brightness of coronary arteries as the preceding factor of developing of coronary artery aneurysm.…”

Section: Discussionsupporting

confidence: 82%

“…Although, Kim et al demonstrated that cTnI level significantly increases in KD patients especially in those with symptomatic myocarditis (18), Checchia et al did not show any the significant findings through the cTnI elevation in KD patients (19). Also, Kaneko et al revealed that NT-proBNP level significantly increases in patients who have developed coronary artery lesion; Their findings were lately confirmed by the study of Adjagba et al and Jung et al (20)(21)(22). In contrast, a study by Iwashima et al did not present any significant differences in levels of NT-proBNP between KD patients with and without coronary artery lesions, however, those patients who developed mitral regurgitation showed significant higher levels of NT-proBNP (21).…”

Section: Introductionmentioning

confidence: 97%

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Cardiac biomarkers for early detection of cardiac involvement in children with Kawasaki disease: a cross-sectional study

Molaei

Khomahani

Ghaffari

et al. 2019

Preprint

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Background Kawasaki disease (KD), which is the second most prevalent vasculitis disease in children after IgA vasculitis, can cause serious cardiovascular complications. Early detection of cardiac involvement in KD is an essential part in managing and preventing the cardiac sequels. Although some cardiac biomarkers such as cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) have recently been suggested for early diagnosis of cardiac involvement in patients with KD, their applicability is still unclear. Thus, this study aimed to compare the levels of cTnI and NT-proBNP in KD child patients with or without cardiac involvement. Methods In this cross sectional study, 32 children with KD who were admitted to the children teaching hospital of Tabriz University of Medical Sciences between April 2015 and April 2018, were consecutively included in the study. For all involved children, the coronary artery involvement defined as coronary artery aneurysm or perivascular brightness of coronary arteries was examined by transthoracic echocardiography, and their serum levels of NT-proBNP and cTnI were measured. Results Of 32 enrolled patients, 4 (9.4%) had cardiac involvement including 3 patients with perivascular brightness of coronary arteries and 1 patient with small aneurysm of the coronary arteries. In all study patients, the cTnI levels were lower than 0.35 and the NT-proBNP assessments revealed an average of 678.5 pg/ml. Children with cardiac involvement had significantly higher NT-proBNP (p-value, 0.001). ROC analysis for power of the NT-proBNP in predicting the cardiac involvement, revealed an excellent power for NT-proBNP (AUC=1.000, p=0.001). Both sensitivity and specificity of NT-proBNP at the optimum cut-off point of 1354 pg/ml were 100 percent. Conclusion Unlike the cTnI, the NT-proBNP can serve as an excellent objective test for early detection of cardiac involvement. Therefore, in KD-patients with high levels of NT-proBNP additional therapy and closer follow up should be considered.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Cardiac biomarkers for early detection of cardiac involvement in children with Kawasaki disease: a cross-sectional study

Molaei

Khomahani

Ghaffari

et al. 2019

Preprint

View full text Add to dashboard Cite

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“…In a prospective study including 109 patients, patients with elevated NT-proBNP had a significantly higher rate of coronary artery dilation (defined as a Z-score ≥ 2.5) at the time of diagnosis (22% vs. 6%, p = 0.03) in a series where the rate of coronary artery dilation regressed at a 2–3 month follow-up (with an odds ratio of remaining dilatation of 1.28 (95% confidence interval 0.23–8.30) [ 38 ]. Similarly to IVIG resistance, while NT-proBNP Z-score for age was associated with coronary artery dilation, the diagnostic cut-off value of 190 pg/mL used for diagnosis of KD was not predictive of coronary involvement [ 25 , 40 ]. Instead, studies have reported cut-off values between 515–1300 pg/mL to predict coronary artery dilation, with a sensitivity and specificity of 73–95% and 61–85%, respectively [ 17 , 36 , 37 , 40 ].…”

Section: Nt-probnp and Coronary Artery Lesionsmentioning

confidence: 99%

“…Similarly to IVIG resistance, while NT-proBNP Z-score for age was associated with coronary artery dilation, the diagnostic cut-off value of 190 pg/mL used for diagnosis of KD was not predictive of coronary involvement [ 25 , 40 ]. Instead, studies have reported cut-off values between 515–1300 pg/mL to predict coronary artery dilation, with a sensitivity and specificity of 73–95% and 61–85%, respectively [ 17 , 36 , 37 , 40 ].…”

Section: Nt-probnp and Coronary Artery Lesionsmentioning

confidence: 99%

A Decade of NT-proBNP in Acute Kawasaki Disease, from Physiological Response to Clinical Relevance

Dionne

Dahdah

2018

Children

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Kawasaki disease (KD) is an inflammatory febrile illness of early childhood and the primary cause of acquired heart disease during childhood. Coronary artery aneurysms (CAA) are a serious complication of KD, leading to ischemic heart disease, myocardial infarction, and sudden cardiac death. Timely diagnosis in the first ten days of fever is crucial to reduce the risk of coronary artery complications. Nitrogen-terminal B-type natriuretic peptide (NT-proBNP), originally used for the management of adults with heart disease, was shown to be useful in the diagnosis and management of patients with KD. NT-proBNP is released by cardiomyocytes in response to mechanical factors such as the dilation of cardiac chambers, and to pro-inflammatory cytokines. The utility of NT-proBNP as a biological marker in KD is based on the universal myocardial inflammatory component early in the course of the disease. Patients with KD have higher NT-proBNP at the time of diagnosis than febrile controls, with a pooled sensitivity of 89% (95% confidence interval 78–95), and a specificity of 72% (95% confidence interval 58–82). The positive likelihood ratio is 3.2:1 (95% confidence interval 2.1–4.8). Moreover, patients with resistance to intravenous immunoglobulin treatment and CAA were found to have higher levels of NT-proBNP, suggesting a prognostic role. Nevertheless, the non-specificity of NT-proBNP to KD limits its use as a stand-alone test. In this light, a tentative associative retrospective diagnostic algorithm was highly reliable for including all cases at risk of CAA, which warrants further prospective studies for a better diagnostic index of suspicion and risk stratification of patients.

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Care of the Child with a Possible Rheumatological Disorder

John

Kenney-Riley

2022

Pediatric Diagnostic Labs for Primary Care: An Evidence-Based Approach

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N-terminal pro-brain natriuretic peptide and prediction of coronary artery dilatation in hyperacute phase of Kawasaki disease

Cited by 11 publications

References 11 publications

Cardiac biomarkers for early detection of cardiac involvement in children with Kawasaki disease: a cross-sectional study

Cardiac biomarkers for early detection of cardiac involvement in children with Kawasaki disease: a cross-sectional study

A Decade of NT-proBNP in Acute Kawasaki Disease, from Physiological Response to Clinical Relevance

Care of the Child with a Possible Rheumatological Disorder

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