The Role of N-Terminal Pro-B-Type Natriuretic Peptide in the Diagnosis of Congestive Heart Failure in Children - Correlation With the Heart Failure Score and Comparison With B-Type Natriuretic Peptide -

Abstract

Background: Both B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) are useful biomarkers for the assessment of congestive heart failure (CHF) in adults. The purpose of this study was to determine whether BNP and NT-proBNP levels could be used to stratify the severity of CHF in children. Methods and Results:The study comprised 181 children with CHF and 232 healthy children aged from 4 months to 14 years who were categorized into CHF grades I, II, III and IV according to the modified Ross scoring system. The plasma BNP and serum NT-proBNP levels were significantly correlated with increasing CHF grades. The NT-proBNP levels were significantly different among the 4 CHF grades. However, only 2 significant differences were observed in the BNP levels between each CHF grade. NT-proBNP testing with cut-off points of >438 pg/ml (≥grade II), >1,678 pg/ml (≥grade III) and >7,734 pg/ml (grade IV) in the patients below 3 years of age, and >295 pg/ml (≥grade II), >1,545 pg/ml (≥grade III) and >3,617 pg/ml (grade IV) in those above 3 years of age was determined to be highly sensitive and specific by receiver operating characteristic analysis. Conclusions:The blood levels of BNP and NT-proBNP therefore reflect the severity of CHF in children. In particular, NT-proBNP is a useful biomarker for evaluating CHF in children. (Circ J 2010; 74: 998 - 1005)

Usefulness of amino terminal pro-B-type natriuretic peptide in evaluating children with cardiac failure

“…The uniform diagnostic tool for heart failure may have accounted for the similarity in findings. However, unlike other studies (11,17,18) the relationship between plasma NT-proBNP and the severity of heart failure in this study was not uniform as the subjects with moderate heart failure had a lower mean plasma NT-proBNP compared to those with mild heart failure. This may be due to the fact that infants who tend to have higher NT-proBNP values (27) contributed more to subjects with mild and severe forms of heart failure in contrast to those with moderate heart The mortality rate in this study was 3.2% which is lower than the 5.34% reported previously by Sadoh et al (30) in the same study area and 11.1% by Anah and co-workers (5).…”

“…(ng/L being the same as pg/mL) Subjects with severe heart failure had significantly higher mean NT-proBNP value compared to mild and moderate categories. This finding is akin to reports by Ekure et al (18), and Sugimoto et al (11) both noted an increasing plasma NT-proBNP with worsening degree of heart failure. The uniform diagnostic tool for heart failure may have accounted for the similarity in findings.…”

“…The plasma levels of these peptides, especially the B-type natriuretic peptide (BNP) and its inactive metabolite, amino-terminal pro B type natriuretic peptide (NT-proBNP) are elevated in subjects with heart failure and increase with worsening degree of heart failure (11,12). The use of these peptides in guiding patient care has been associated with reduced mortality, shorter duration of hospital stay and more event-free post-discharge period (13,14).…”

“…However, these studies (13,14) were mainly done in adults in whom cardiac failure is of a different etiopathogenesis, compared to cardiac failure in children. The few studies in children (11,12) have not included the etiologic factors of heart failure as seen in our locale such as bronchopneumonia, septicemia and severe anemia (4)(5)(6)15). Furthermore, the cut-off values that have been reported have varied widely depending on the study population and the outcome parameter being evaluated.…”

Diagnostic Usefulness of N-terminal Pro-brain Natriuretic Peptide among Children with Heart Failure in a Tertiary Hospital in Lagos, Nigeria

“…15 Similar studies on children have equally shown that plasma levels of NT-proBNP are good for diagnosing heart failure and may be used as a screening test. [16][17][18] Wu et al in China reported a sensitivity and specificity of 89.3% and 91.2% respectively when plasma NTproBNP was used to diagnose congestive cardiac failure in children with ventricular septal defect. 16 We note that the sensitivity in our report is significantly lower at 57%.…”