Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-23T02:58:53.788Z Has data issue: false hasContentIssue false
  • English
  • Français

Levels of brain natriuretic peptide in children with right ventricular overload due to congenital cardiac disease

Published online by Cambridge University Press:  13 July 2005

Thomas S. Mir ,
Jan Falkenberg ,
Bernd Friedrich ,
Urda Gottschalk ,
Throng Phi Lê ,
Stephanie Laer  and
Jochen Weil
Thomas S. Mir
Affiliation:
Herzzentrum, Klinik und Poliklinik für Kinderkardiologie, Hamburg, Germany
Jan Falkenberg
Affiliation:
Herzzentrum, Klinik und Poliklinik für Kinderkardiologie, Hamburg, Germany
Bernd Friedrich
Affiliation:
Herzzentrum, Klinik und Poliklinik für Kinderkardiologie, Hamburg, Germany
Urda Gottschalk
Affiliation:
Herzzentrum, Klinik und Poliklinik für Kinderkardiologie, Hamburg, Germany
Throng Phi Lê
Affiliation:
Herzzentrum, Klinik und Poliklinik für Kinderkardiologie, Hamburg, Germany
Stephanie Laer
Affiliation:
Zentrum für Experimentelle Medizin, Institut für Experimentelle und Klinische Pharmakologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
Jochen Weil
Affiliation:
Herzzentrum, Klinik und Poliklinik für Kinderkardiologie, Hamburg, Germany
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: To evaluate the role of the concentration of brain natriuretic peptide in the plasma, and its correlation with haemodynamic right ventricular parameters, in children with overload of the right ventricle due to congenital cardiac disease. Methods: We studied 31 children, with a mean age of 4.8 years, with volume or pressure overload of the right ventricle caused by congenital cardiac disease. Of the patients, 19 had undergone surgical biventricular correction of tetralogy of Fallot, 11 with pulmonary stenosis and 8 with pulmonary atresia, and 12 patients were studied prior to operations, 7 with atrial septal defects and 5 with anomalous pulmonary venous connections. We measured brain natriuretic peptide using Triage®, from Biosite, United States of America. We determined end-diastolic pressures of the right ventricle, and the peak ratio of right to left ventricular pressures, by cardiac catheterization and correlated them with concentrations of brain natriuretic peptide in the plasma. Results: The mean concentrations of brain natriuretic peptide were 87.7, with a range from 5 to 316, picograms per millilitre. Mean end-diastolic pressure in the right ventricle was 5.6, with a range from 2 to 10, millimetres of mercury, and the mean ratio of right to left ventricular pressure was 0.56, with a range from 0.24 to 1.03. There was a positive correlation between the concentrations of brain natriuretic peptide and the ratio of right to left ventricular pressure (r equal to 0.7844, p less than 0.0001) in all patients. These positive correlations remained when the children with tetralogy of Fallot, and those with atrial septal defects or anomalous pulmonary venous connection, were analysed as separate groups. We also found a weak correlation was shown between end-diastolic right ventricular pressure and concentrations of brain natriuretic peptide in the plasma (r equal to 0.5947, p equal to 0.0004). Conclusion: There is a significant correlation between right ventricular haemodynamic parameters and concentrations of brain natriuretic peptide in the plasma of children with right ventricular overload due to different types of congenital cardiac disease. The monitoring of brain natriuretic peptide may provide a non-invasive and safe quantitative follow up of the right ventricular pressure and volume overload in these patients.

Keywords

Brain natriuretic peptidepaediatricsventricular function
Type
Original Article
Information
Cardiology in the Young , Volume 15 , Issue 4 , August 2005 , pp. 396 - 401
Copyright
© 2005 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Clerico A, Emdin M. Diagnostic accuracy and prognostic relevance of the measurement of cardiac natriuretic peptides: a review. Clin Chem 2004; kala USA 50: 33–50.
Maisel A. B-type natriuretic peptide levels: a potential novel “white count” for congestive heart failure. J Card Fail 2001; 7: 183–193.Google Scholar
Maisel A, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002; 347: 161–167.Google Scholar
Sagnella A. Measurement and importance of plasma brain natriuretic peptide and related peptides. Ann Clin Biochem 2001; 38: 83–93.Google Scholar
Cowie MR, Mendez GF. BNP and congestive heart failure. Prog Cardiovasc Dis 2002; 44: 293–321.Google Scholar
Levin E, Gardner D, Samson W. Natriuretic peptides. N Engl J Med 1998; 339: 321–327.Google Scholar
Troughton RW, Frampton CM, Yandle TG, Espiner EA, Nicholls MG, Richards AM. Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations. Lancet 2000; 355: 1126–1130.Google Scholar
McDonagh TA, Cunningham AD, Morrison CE, et al. Left ventricular dysfunction, natriuretic peptides, and mortality in an urban population. Heart 2001; 86: 21–26.Google Scholar
Talwar S, Siebenhofer A, Williams B, Ng LL. Influence of hypertension, left ventricular hypertrophy, and left ventricular systolic dysfunction on plasma N terminal pro BNP. Heart 2000; 83: 278–282.Google Scholar
Koch A, Singer H. Normal values of B type natriuretic peptide in infants, children, and adolescents. Heart 2003; 89: 875–878.Google Scholar
Mir TS, Marohn S, Läer S, Eiselt M, Grollmus O, Weil J. Plasma concentrations of N-terminal-pro brain natriuretic peptide in children from neonatal period to adulthood and in children with congestive heart failure. Pediatrics 2002; 110: 1–6.Google Scholar
Cowley CG, Bradley JD, Shaddy RE. B-type natriuretic peptide levels in congenital heart disease. Pediatr Cardiol 2004; 25: 336–340.Google Scholar
Tulevski II, Groenink M, van der Wall EE, et al. Increased brain and atrial natriuretic peptides in patients with chronic right ventricular pressure overload: correlation between plasma neurohormones and right ventricular dysfunction. Heart 2001; 86: 27–30.Google Scholar
Tulevski II, Dodge-Khatami A, Groenink M, van der Wall EE, Romkes H, Mulder BJ. Right ventricular function in congenital cardiac disease: non-invasive quantitative parameters for follow up. Cardiol Young 2003; 13: 397–403.Google Scholar
Kruger S, Graf J, Merx MW, et al. Brain natriuretic peptide predicts right heart failure in patients with acute pulmonary embolism. Am Heart J 2004; 147: 60–65.Google Scholar
Tsutamoto T, Wada A, Maeda K, et al. Attenuation of compensation of endogenous cardiac natriuretic peptide system in chronic heart failure: prognostic role of plasma brain natriuretic peptide concentration in patients with chronic symptomatic left ventricular dysfunction. Circulation 1997; 96: 509–516.Google Scholar
Cheng V, Kazanagra R, Garcia A, et al. A rapid bedside test for B-type peptide predicts outcomes in patients admitted for decompensated heart failure: a pilot study. J Am Coll Cardiol 2001; 37: 386–391.Google Scholar
Koulouri S, Acherman RJ, Wong PC, Chan LS, Lewis AB. Utility of B-type natriuretic peptide in differentiating congestive heart failure from lung disease in pediatric patients with respiratory distress. Pediatr Cardiol 2004; 25: 341–346.Google Scholar
Mir TS, Laux R, Hellwege HH, et al. Plasma N-terminal pro-atrial-natriuretic peptide and plasma N-terminal-pro brain natriuretic peptide in healthy neonates: marked and rapid increase after birth. Pediatrics 2003; 112: 896–899.Google Scholar