Natriuretic Peptide as an Adjunctive Diagnostic Test in the Acute Phase of Kawasaki Disease

Abstract

Coronary arteritis rather than myocardial involvement is typically emphasized in Kawasaki disease (KD). Moreover, the criteria and the usual biological markers oversee the importance of cardiac-specific markers in diagnosing this disease. We sought to study the clinical usefulness of measuring B-type natriuretic peptide (BNP) and its N-terminal moiety (NT-proBNP) at the onset of KD. Our objective was to evaluate blood concentrations of BNP and NT-proBNP during the acute and subacute phases of KD. We conducted a prospective study comparing newly diagnosed KD patients to non-KD febrile controls. Blood specimens were collected at presentation, 6-12 h after intravenous immunoglobulin (IVIG) therapy, 1-2 weeks later, and 2-3 months later, or only upon reenrollment for controls. Forty-there KD and 19 control patients were enrolled consecutively. The mean age was 47.1 +/- 34.3 and 62.2 +/- 44.9 months, respectively (p = NS). Pre-IVIG NT-proBNP levels were significantly higher in KD patients than in controls (923.6 +/- 1361.7 vs. 186.2 +/- 198.0 ng/L; p < 0.001), with no statistical difference for BNP (141.9 +/- 227.5 vs. 59.9 +/- 72.4 ng/L; p = 0.112). In conclusion, our data indicate that NT-proBNP is a better marker of myocardial involvement in acute KD than BNP, particularly in cases with incomplete diagnostic criteria, and suggest that it may be a valid adjunctive diagnostic method to support the diagnosis of KD.

Kawasaki Disease, Others Heart Injuries, Not Only Coronary Arteritis

“…diffuse fibrosis or local scarring in regions of myocardial, ischemia or infarct (Takahasi, 1989;Dahdah, 2009). KD-associated inflammatory damage can potentially affect all of the components of the cardiovascular system and even other bodily areas as a consequence of vasculitis; thus, systematic follow-up is necessary until adult age in all children who have had this disease, even when his/her manifestations have not been severe, and especially in these children who manifested myocarditis without coronary artery injuries, because to date we do not know the characteristics and long-term consequences of this particular problem.…”

“…The pathogenesis of these myocardiac injuries and their consequences in the long term with respect to the heart are little understood to date and should not be underestimated; thus, it is necessary to establish methodological follow-up patterns in these patients. The possibility has also been set forth of reclassifying the clinical signs and other findings regarding left ventricle dysfunction in KD (Gordon, 2009;Dahdah, 2009). …”

“…In addition, with positive C-reactive protein in concentrations >6 mg/l, other studies have been recommended that suggest vasculitis, such as the following: Antinuclear antibodies (ANA); Anti-neutrophil cytoplasmic antibodies (ANCA), and endothelial anti-cellular antibodies, which have not demonstrated full usefulness and that can lead to confusion; in determination of Creatinine phospho kinase (CPK), MB fractions are useful for patients with very severe clinical pictures and with risk points that suggest greater susceptibility for presenting myocardial infarct. Methods have also been developed, such as determination of tryptophase and kynurenine in plasma by the liquid chromatography method, finding higher levels in patients with KD; this is a method that, once validated, could have an application as a useful laboratory diagnostic index; also, in patients with atypical clinical situations, it has been suggested that determination of natiuretic peptides is a good marker of evolution to myocardial infarct, and it has been recommended that this could be added to the diagnostic tests (Card, 2009;Dahdah, 2009;Kurotobi, 2005;Javadzagean, 2009;Newburger, 2004;Shulman, 2003;Zhan, 2009). It has been found recently that early neutropenia indicates that circulating neutrophils on day 10 of illness evolution can play an important role in following the sequence of the formation of coronary artery injuries (Onouchi, 2009).…”

Kawasaki Disease; A Review Article

“…It is associated with cardiomyocyte stress, markers of inflammation, oxidative stress, and echocardiographic measurements. Presence of NT-proBNP suggests diastolic dysfunction (28). Some researchers propose that NT-proBNP may be an excellent biomarker for supporting the diagnosis of KD (29).…”

Brain Natriuretic Peptide as a Novel Diagnostic Biomarker in Kawasaki Disease

“…All found significant diagnostic values for KD as shown in Table 1. Dahdah et al reported a clear advantage of NT-proBNP over BNP indicating superiority as a diagnostic biomarker in KD (7). This might be due to different half-lives of BNP and NT-proBNP (20-30 minutes versus 60-120 minutes, respectively).…”