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

cardiac disease
Article author query
mir ts [PubMed][Google Scholar]
falkenberg j [PubMed][Google

Thomas
S. Mir
alk
a1

, Jan Falkenberg

a1c1

, Throng Phi L

a1

, Bernd Friedrich

a1

, Stephanie Laer

a1

a2

, Urda Gottsch

a1

and Jochen Weil

a1

Herzzentrum, Klinik und Poliklinik fr Kinderkardiologie, Hamburg,

Germany
a2

Zentrum fr Experimentelle Medizin, Institut fr Experimentelle

und Klinische Pharmakologie, Universittsklinikum HamburgEppendorf, Hamburg, Germany

Scholar]
friedrich b [PubMed][Google
Scholar]
gottschalk u [PubMed][Google
Scholar]
le tp [PubMed][Google Scholar]
laer s [PubMed][Google Scholar]
weil j [PubMed][Google Scholar]

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 noninvasive and safe quantitative follow up of the right ventricular pressure and volume
overload in these patients.

Neurohormonal and cytokine fluctuations following transcatheter

closure for an atrial septal defect

Aikaterini C. Chamakoua, , ,
Eleni Dedea,

Antonia Moutafia,
Vassileios Thanopoulosb,
Stavros Chryssanthopoulosa,
Sophia Loukopouloub,
Christos Pitsavosc,
Christodoulos Stefanadisc,
Constantinos H. Davosa, ,
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doi:10.1016/j.cyto.2011.10.002
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Abstract
Introduction
Inflammation and neurohormonal activation are considered to be involved in the
development of earlier and/or later complications in congenital heart disease patients, even
after a successful repair of the lesion. It is not yet clarified what is the role of the therapeutic
interventions in the occurrence of such a response and how it could be associated with
possible postoperative complications.

Aim
We sought to assess the inflammatory and neurohormonal response to transcatheter closure
of secundum type atrial septal defects (ASD) over a six-month follow-up period. We also
evaluated the association between the respective markers and catheterization data as well
as echocardiographic measurements.

Methods
Plasma concentrations of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-),
interleukin-10 (IL-10), N-terminal-proatrial natriuretic peptide (NT-proANP) and N-terminalprobrain natriuretic peptide (NT-proBNP) were assessed and echocardiographic
measurements were performed in twenty-eight patients with atrial septal defect prior to, and
at the first, second and sixth months post transcatheter closure. Thirty-three age-matched
healthy volunteers were also enrolled.

Results
IL-6 plasma levels, although higher preoperatively, [physical logarithm (ln) IL-6: 3.37 0.66
vs 2.92 0.44 pg/ml, p = 0.015], reached control levels postoperatively, at the end of the
third month, whereas TNF- and IL-10 were not influenced by the procedure. NT-proANP
levels were elevated preoperatively compared to the control group (ln NT-proANP
3.78 0.572 vs 3.48 0.30, p = 0.031), with a further significant increase during the 1st
month (ln NT-proANP 3.78 0.572 vs 4.2 0.42, p = 0.006), following the pattern of the left
atrial volume enlargement, and remained high even 6 months after the procedure .On the
other hand, the initially normal concentrations of NT-proBNP, after a transient significant
increase during the first month postoperatively (ln NT-proBNP 3.56 0.94 vs
4.58 0.91, p < 0.0001) returned to the controls levels at the end of the third month.
Preoperative concentrations of NT-proANP positively correlated with NT-proBNP
concentrations and pulmonary to systemic flow ratio (Qp/Qs).

Conclusions
Transcatheter closure could improve, on a mid- term basis, the inflammatory process but
natriuretic peptides secretion continues in parallel with left atrial volume increase. Further
follow up is required to determine the long-term progress of the inflammatory and
neurohormonal response to the procedure.

Relationship between Pericardial Fluid B-type Natriuretic Peptide

and Ventricular Structure and Function

Li-Ping Chena,
Tie-Min Weia,
Le-Xin Wangb, ,
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doi:10.1016/j.arcmed.2006.12.006
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Background
We undertook this study to investigate the levels of pericardial B-type natriuretic peptide
(BNP) and its relationship with ventricular structure and function.

Methods
Pericardial and plasma BNP concentrations were measured in 18 patients with congenital
ventricular septal defect.

Results
The mean level of BNP in the pericardial fluid (324.8 137.3 pg/mL) was higher than the
plasma (20.8 6.1 pg/mL) (p = 0.03). Pericardial BNP was correlated with the plasma BNP
(r = 0.85, p <0.01). A good correlation was also found between the pericardial BNP and left
atrial diameter, left ventricular end-diastolic and end-systolic diameter, left ventricular
ejection fraction, right ventricular diameter and pulmonary artery systolic pressure
(p <0.05).

Conclusions
The levels of BNP in pericardial fluid were higher than in the plasma. Similar to plasma BNP,
pericardial BNP is also related to the ventricular structure and function.

Brain Natriuretic Peptide Levels Before and After Ventricular

Septal Defect Repair

Richard D. Mainwaring, MDa, , ,

Carol Parise, PhDb,
Stanley B. Wright, MDa,
Andrew L. Juris, MDa,
Robert A. Achtel, MDa,
Hessam Fallah, MDa
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doi:10.1016/j.athoracsur.2007.07.021
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Background
Brain natriuretic peptide is a relatively recently discovered circulating mediator that has
been correlated with the degree of heart failure in adults. This study evaluated the
preoperative and postoperative brain natriuretic peptide levels in infants and children
undergoing ventricular septal defect repair.

Methods
The study enrolled 18 infants and children (ages 2 months to 15.6 years) scheduled for
surgical repair of their ventricular septal defects. Brain natriuretic peptide levels were drawn
preoperatively and then postoperatively at 1, 24, 48, and 72 hours. The amount of shunt
(the ratio of pulmonary blood flow [Q p]/systemic blood flow [Qs]) through the ventricular
septal defect was determined by saturation levels performed in the catheterization
laboratory or intraoperatively.

Results
The preoperative brain natriuretic peptide levels (pg/mL) averaged 78 57, and the
postoperative levels were 168 241 at 1 hour, 418 330 at 24 hours, 405 364 at 48
hours, and 391 397 at 72 hours. These differences were significant for each postoperative
time point compared with preoperative values. Preoperative brain natriuretic peptide and
the Qp/Qs were significantly correlated (age-adjusted R2 = 0.33,p < 0.001).

Conclusions
Brain natriuretic peptide levels have a close correlation with the physiologic volume load
caused by ventricular septal defects. The preoperative brain natriuretic peptide levels were
also found to be predictive for the postoperative time course of brain natriuretic peptide
level changes. These results suggest that brain natriuretic peptide levels may be a useful
clinical marker in infants and children with ventricular septal defects.

B-Type Natriuretic Peptide and Heart Failure in

Patients with Ventricular Septal Defect: A Pilot Study

Michael A. Paul,
Carl L. Backer,
Helen J. Binns,
Constantine Mavroudis,
Catherine L. Webb,
Ram Yogev,
Wayne H. Franklin
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Abstract
In adults without congenital heart disease, B-type natriuretic peptide (BNP) has been shown
to be a very sensitive and specific marker of heart failure. The utility of BNP as a marker of
clinical heart failure in children with a ventricular septal defect (VSD) has yet to be
determined. A prospective, observational study evaluated BNP levels and other measures of
heart failure. Eligible patients were <2 years old, scheduled to undergo surgical repair of a
VSD, and without other significant structural heart disease. Data collected before and after

surgical repair included echocardiographic measurements, electrocardiographic (ECG)

findings, Ross score, BNP measurements, and weight gain. A total of 21 patients were
enrolled and 14 patients had complete postoperative follow-up data. For patients with
complete data, mean BNP decreased by 94 pg/ml (118 pre vs. 24 post; paired ttest, p = 0.041), mean left ventricular end-diastolic dimension z-score decreased by 1.75
(+0.86 vs. 0.89; paired t-test, p = 0.013), mean weight z-score change per month
increased by 0.35 (0.25 vs. +0.10; Wilcoxon test, p = 0.013), and the incidence of
biventricular hypertrophy on ECG decreased (46% vs. 0%; McNemar test, p = 0.031). The
change in BNP showed a trend toward a negative correlation with weight z-score change per
month (r = 0.531, p = 0.075). In conclusion, BNP, along with other measures of heart
failure, decreased following VSD repair, and the change in BNP was most closely correlated
with improved weight gain.

Clinical implication of plasma natriuretic peptides in children with ventricular septal defect
1.

Kenji Suda1,

2.

Masahiko Matsumura1and

3.

Masahiko Matsumoto2
Article first published online: 26 JUN 2003
DOI: 10.1046/j.1442-200X.2003.01716.x
Issue

Pediatrics International
Volume 45, Issue 3, pages 249254, June 2003

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Keywords:

A-type natriuretic peptide;

B-type natriuretic peptide;

pulmonary artery pressure;

ventricular septal defect

AbstractBackground:There is little information available concerning plasma concentrations of B-type natriuretic

peptide (BNP) in children with a ventricular septal defect. The aim of the present study was to determine
hemodynamic factors that control plasma concentrations of BNP and the clinical implications of BNP compared with
atrial natriuretic peptide (ANP) in children with ventricular septal defect.
Methods:Fifty-nine patients with ventricular septal defect (28 boys and 31 girls) without pulmonary vascular disease
were enrolled. The patients ages ranged from 3 months to 13 years (mean 3.1 years). Plasma BNP and ANP were

determined by immunoradiometric assay. Hemodynamic variables derived from cardiac catheterization were
analyzed in terms of correlation with BNP and ANP.
Results:It was found that plasma BNP significantly positively correlated with ANP (ANP = 2.1 BNP + 25 pg/mL; r=
0.81, P < 0.0001) and BNP never exceeded ANP in the present patient series. Plasma BNP as well as ANP
significantly positively correlated with pulmonary to systemic flow ratio (r = 0.65 and r= 0.59, respectively) and mean
pulmonary artery pressure (r = 0.72 and r= 0.68, respectively). In addition, plasma BNP of 20 pg/mL and ANP of
50 pg/mL identified children with mean pulmonary artery pressure of 20 mmHg with a sensitivity of 82% and 97%,
respectively, and a specificity of 89% and 84%, respectively.
Conclusion:Plasma BNP and ANP reflect pressure and volume loads to the pulmonary artery and right ventricle
and may help to identify children with ventricular septal defect complicated by pulmonary hypertension that demands
early interventi

Paradoxical Relationship Between B-type Natriuretic

Peptide and Pulmonary Vascular Resistance in
Patients with Ventricular Septal Defect and
Concomitant Severe Pulmonary Hypertension

Manatomo Toyono,
Kenji Harada,
Masamichi Tamura,
Mieko Aoki-Okazaki,
Shunsuke Shimada,
Jun Oyamada,
Goro Takada
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Abstract
B-type natriuretic peptide (BNP) reflects volume overload on left ventricle and pulmonary
hypertension (PH) in patients with ventricular septal defect (VSD). Pulmonary vascular

resistance (PVR) has been reported to correlate positively with BNP in VSD patients with
various degrees of PH. We aimed to investigate the relationship between PVR and BNP in
VSD patients with severe PH. We examined 24 subjects with VSD concomitant severe PH
aged from 2 months to 17 years (median: 4 months). The ratio of pulmonary to systemic
pressure (Pp/Ps), the ratio of pulmonary to systemic flow (Qp/Qs), the ratio of pulmonary to
systemic resistance (Rp/Rs), and PVR were determined by cardiac catheterization. PVR and
Rp/Rs ranged from 1.6 to 15.5 (mean: 5.7 3.9) Wood unit m2 and 0.1 to 0.8 (mean:
0.4 0.2), respectively. BNP ranged from 5.5 to 69 (mean: 31 19) pg/ml. Negative
correlations were observed between BNP and PVR (r = -0.56, p = 0.004) and BNP and Rp/Rs
(r = -0.51, p = 0.01). BNP was significantly lower (<10 pg/ml) in VSD patients with
Eisenmenger physiology as compared with the others (p = 0.003). We should draw attention
to evaluate BNP values in VSD patients with severe PH.

[Diagnostic value of plasma concentration of pro-brain natriuretic peptide in

congestive heart failure in pediatric patients with ventricular septal defects].
(PMID:15833183)

Abstract

Citations

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Related Articles

External Links
Wu YR, Chen SB, Huang MR, Zhang YQ, Sun K, Chen S
Cardiology Department, Shanghai Children's Medical Center, Shanghai 200127, China.
Zhonghua er ke za Zhi. Chinese Journal of Pediatrics [2005, 43(3):161-164]
Type: Journal Article, English Abstract (lang: chi)

Abstract

Highlight Terms
Diseases(4)

Genes/Proteins(2)

OBJECTIVE: The value of plasma brain natriuretic peptide (BNP) and N-terminal proBNP (NTproBNP) can reflect cardiac function and therefore can be used for diagnosing congestive
heart failure (CHF) and evaluating cardiac function. There are few reports, however, on the
value of BNPand NT-proBNP in pediatric cases of congenital heart defect. The aim of this
study was to assess the value of plasma NT-proBNP in the diagnosis of CHF and evaluation

of cardiac function in pediatric patients with ventricular septal defect (VSD).

METHODS: Fifty-one patients with VSD aged from 2 months to 2 years old (mean 7.9
months) were enrolled. According to the modified Ross Score, the patients were divided into
three groups, no CHFgroup (20 patients), mild CHF group (18 patients) and moderate to
severe CHF group (13 patients). Fifteen age-matched normal children were used as controls.
Plasma NT-proBNP was measured using enzyme immunoassay. All patients had complete
echocardiographic study, including measurement of left ventricular end diastolic volume
index (LVEDVI), left ventricular end systolic wall stress (LVSEWS), heart rate corrected mean
velocity of circumferential fiber shortening (mVcFc), left ventricular ejection fraction (LVEF),
left ventricular fractional shortening (LVFS), and contractility index (Con). The correlation
between plasma NT-proBNP level and modified Ross Score and echocardiographic cardiac
functional indexes was determined. The sensitivity, specificity and ROC curve of plasma NTproBNP for diagnosing CHF was studied.
RESULTS: Plasma NT-proBNP was positively correlated with modified Ross Score (r = 0.75, P
< 0.01). Plasma NT-proBNP concentration in moderate to severe CHF group (2061 +/- 908)
fmol/ml was significantly higher than that of mild CHF group (810 +/- 335) fmol/ml, and
Plasma NT-proBNP concentration in mild CHF group was higher than that in no CHF group
(309 +/- 68) fmol/ml. 97.14% of normal controls and subjects in no CHF group had their
plasma NT-proBNP below 400 fmol/ml. 83.3% of children in mild CHF group had their plasma
NT-proBNP between (400-1400) fmol/ml while in moderate and severe CHF group 84.6% of
children had their plasma NT-proBNP beyond 1400 fmol/ml. Plasma NT-proBNP was also
positively correlated with LVEDVI and LVSEWS. There was no correlation among mVcFc,
LVEF, LVFS, Con and plasma NT-proBNP concentration. Using plasma NT-proBNP
concentration > or = 400 fmol/ml as cut-point for diagnosing CHF, the sensitivity was
89.3%, the specificity was 91.2%, and the area under the ROC curve was 0.944.
CONCLUSIONS: Plasma NT-proBNP level could be used to assess cardiac function and
diagnoseCHF in pediatric patients with VSD.

Diagnostic performance of BNP and NT-ProBNP measurements in

children with heart failure based on congenital heart defects and
cardiomyopathies

Murat ahina, , ,
Oytun Portakalb,
Tevfik Karagza,
Glen Haselikb,
Sheyla zkutlua
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doi:10.1016/j.clinbiochem.2010.08.002
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Abstract
Objectives
To test the diagnostic performance of BNP and NT-ProBNP in children with different
hemodynamic dysfunctions. 3

Design and methods

Seventy children who underwent echocardiography and were classified into left and right
ventricle volume and pressure overload (LVvO, LVpO, RVvO, and RVpO, respectively) and
biventricular volume overload (BVvO) were enrolled.

Results
BNP and NT-ProBNP levels in all groups were higher than those in the control group
(p < 0.001, p < 0.001). The increase in peptide levels was strongly correlated with the
severity of heart failure (p < 0.001, p < 0.001). There was no significant difference in
peptide levels in-between LVvO, LVpO, RVvO, RVpO and BVvO groups. Both measurements
were significantly correlated (r = 0.76, p < 0.001) with each other. NT-ProBNP showed a high
sensitivity, whereas BNP showed a high specificity and accuracy. AUCs in ROC-curve were
0.97 for BNP and 0.96 for NT-ProBNP.

Conclusions
NT-ProBNP may be used in screening of risk groups for cardiac failure because of its' higher
sensitivity, but BNP may be specifically used in monitoring patients with heart failure.