Paediatric heart failure – understanding the pathophysiology and the current role of cardiac biomarkers in clinical practice

McGinn, Claire; Casey, Frank; Watson, Chris; Morrison, Louise

doi:10.1017/s1047951123000331

Cited by 5 publications

(6 citation statements)

References 93 publications

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“…Acquired heart diseases, such as Kawasaki disease, myocarditis, endocarditis, and rheumatic fever, result in HF through inflammation and myocardial injury, leading to valvular dysfunction and decreased myocardial contractility and cardiac output. In valvular heart disease, regurgitation and stenosis cause volume and pressure overload, respectively, resulting in ventricular remodeling and dysfunction [ 9 , 10 ].…”

Section: Pathophysiologymentioning

confidence: 99%

“…Over time, these compensatory mechanisms become maladaptive, leading to progressive ventricular dysfunction and worsening of HF through adverse cardiac remodeling. The release of proinflammatory cytokines and chemokines also contributes to myocardial damage and inflammation [ 9 , 10 ].…”

Section: Pathophysiologymentioning

confidence: 99%

“…These children may exhibit signs of cerebral hypoperfusion such as irritability, altered mental status, and lethargy. Peripheral cyanosis and pallor have also been observed [ 3 , 4 , 9 , 10 ].…”

Section: Clinical Presentationsmentioning

confidence: 99%

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Heart failure in children and adolescents: an update on diagnostic approaches and management

Agrawal,

Janjua,

Alsayed Ali Zeyada

et al. 2024

Clin Exp Pediatr

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Cardiac failure is a clinical syndrome that may develop in children owing to cardiac dysfunction or underlying structural heart diseases. Considering the differences in diagnostic and therapeutic approaches for pediatric heart failure (PHF) and adult heart failure, we have reviewed the current literature on PHF. Relevant studies were extracted from MEDLINE/PubMed, Google Scholar, and Clinical Trial Registries using the terms “pediatric heart failure” or “heart failure in children” and “management” or “decongestive therapy.” Recent advances in diagnostic approaches, such as cardiac magnetic resonance, speckle-tracking echocardiography, tissue Doppler imaging, and molecular diagnostic techniques, have increased our under -standing of PHF. It is imperative that clinicians evaluate the interrelated factors responsible for the develop ment of PHF, including myocardial function, pulmonary and systemic blood flow, heart rhythm, valve function, and nutritional status. Although recent advances have demon strated the efficacy of many new drugs in adult heart failure trials, it cannot be concluded that these drugs will show similar efficacy in children, considering the heterogeneous nature of the underlying mechanisms and variable pharmacody-namics and pharmacokinetics. Therefore, the underlying pathophysiology of PHF and the mechanisms of action of different drugs should be considered when selecting appropriate therapies. Further trials are needed to establi sh the efficacy and safety of these drugs, and a combined mul-ti disciplinary strategy will help enhance PHF outcomes.

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Section: Pathophysiologymentioning

confidence: 99%

Section: Pathophysiologymentioning

confidence: 99%

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Heart failure in children and adolescents: an update on diagnostic approaches and management

Agrawal,

Janjua,

Alsayed Ali Zeyada

et al. 2024

Clin Exp Pediatr

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“…The authors concluded that plasma NT-proBNP represents the best diagnostic marker, with a superiority over both apelin and Gal-3, but suggested that the combination between NT-proBNP and Gal-3 might be the best mortality predictor [ 63 ]. In a similar fashion, a review performed on pediatric studies that enrolled patients diagnosed with heart failure concluded that none of the currently available serum biomarkers of myocardial fibrosis perform as well as NT-proBNP in predicting ventricular dysfunction [ 64 ]. Gal-3 was afterwards regarded by the randomized SHOCK-COOL trial as a stable biomarker that correlates well with a 30-day mortality of different causes in patients with AHF and which is not influenced by age, sex and body mass index [ 65 ].…”

Section: Gal-3 Heart Failure and Its Associated Complicationsmentioning

confidence: 99%

The Role of Galectin-3 in Predicting Congenital Heart Disease Outcome: A Review of the Literature

Făgărășan

Săsăran

Gozar

et al. 2023

IJMS

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Galectin-3 (Gal-3) is a novel pro-fibrotic biomarker that can predict both right and left cardiac dysfunction caused by various cardiovascular conditions. Its expression seems to be progressively altered with evolving cardiac remodeling processes, even before the onset of heart failure. Hence, Gal-3 has been found to be an individual predictor of acute and chronic heart failure or to serve as part of an integrated biomarker panel that can foresee adverse cardiac outcomes. In congenital heart disease (CHD), Gal-3 correlates with cardiac mortality and complications in both children and adults and is proposed as a therapeutic target in order to reverse the activation of pro-fibrosis pathways that lead to heart failure. Positive associations between serum Gal-3 levels, post-operatory hospitalization rates, complications and ventricular dysfunction have also been reported within studies conducted on patients with CHD who underwent corrective surgery. Thus, this review tried to address the potential utility of Gal-3 in patients with CHD and particularly in those who undergo corrective surgery. The heterogeneity of the literature data and the lack of validation of the results obtained by the current studies on larger cohorts cannot be neglected, though. Further longitudinal research is required to establish how Gal-3 can relate to long-term outcomes in pediatric CHD.

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“…Biomarkers were selected based on published scientific data that have suggested a strong relationship between heart failure and elevated blood biomarker levels in various age groups and types of cardiac diseases, both in adults and children. 10 , 11 , 12 , 13 , 14 , 15 , 16 To address the need for timely and efficient detection of high-risk CHD in newborns, we hypothesized that the cardiovascular biomarkers NT-proBNP and IL-1 RL1 could aid this process if analyzed using minimal amounts of dried blood spot (DBS) samples, as commonly used in newborn screening programs.…”

Section: Introductionmentioning

confidence: 99%

Newborn Screening for High-Risk Congenital Heart Disease by Dried Blood Spot Biomarker Analysis

Clausen,

Friberg,

Lannering

et al. 2024

JAMA Netw Open

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ImportanceCongenital heart disease (CHD) is the most common human organ malformation, affecting approximately 1 of 125 newborns globally.ObjectivesAssessing the performance of 2 diagnostic tests using minimal amounts of dried blood spots (DBS) to identify high-risk CHD compared with controls in a Swedish cohort of neonates.Design, Setting, and ParticipantsThis diagnostic study took place in Sweden between 2019 and 2023 and enrolled full-term babies born between 2005 and 2023. All cases were identified through centralized pediatric cardiothoracic surgical services in Lund and Gothenburg, Sweden. Controls were followed up for 1 year to ensure no late presentations of high-risk CHD occurred. Cases were verified through surgical records and echocardiography.ExposureHigh-risk CHD, defined as cases requiring cardiac surgical management during infancy due to evolving signs of heart failure or types in which the postnatal circulation depends on patency of the arterial duct. Using 3-μL DBS samples, automated quantitative tests for NT-proBNP and interleukin 1 receptor-like 1 (IL-1 RL1; formerly known as soluble ST2) were compared against established CHD screening methods.Main Outcomes and MeasuresPerformance of DBS tests to detect high-risk CHD using receiver operating characteristic curves; Bland-Altman and Pearson correlation analyses to compare IL-1 RL1 DBS with plasma blood levels.ResultsA total of 313 newborns were included (mean [SD] gestational age, 39.4 [1.3] weeks; 181 [57.8%] male). Mean (SD) birthweight was 3495 (483) grams. Analyzed DBS samples included 217 CHD cases and 96 controls. Among the CHD cases, 188 participants (89.3%) were high-risk types, of which 73 (38.8%) were suspected prenatally. Of the 188 high-risk cases, 94 (50.0%) passed pulse oximetry screening and 36 (19.1%) were initially discharged after birth without diagnoses. Combining NT-proBNP and IL-1 RL1 tests performed well in comparison with existing screening methods and enabled additional identification of asymptomatic babies with receiver operating characteristic area under the curve 0.95 (95% CI, 0.93-0.98).Conclusions and relevanceIn this diagnostic study, NT-proBNP and IL-1 RL1 DBS assays identified high-risk CHD in a timely manner, including in asymptomatic newborns, and improved overall screening performance in this cohort from Sweden. Prospective evaluation of this novel approach is warranted.

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Paediatric heart failure – understanding the pathophysiology and the current role of cardiac biomarkers in clinical practice

Cited by 5 publications

References 93 publications

Heart failure in children and adolescents: an update on diagnostic approaches and management

Heart failure in children and adolescents: an update on diagnostic approaches and management

The Role of Galectin-3 in Predicting Congenital Heart Disease Outcome: A Review of the Literature

Newborn Screening for High-Risk Congenital Heart Disease by Dried Blood Spot Biomarker Analysis

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