Associations between neurohormonal and inflammatory activation and heart failure in children

Christopher Ratnasamy, Daniel D. Kinnamon, Steven E Lipshultz, Paolo Rusconi

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Abstract

Background: Adult heart failure (HF) has been shown to be associated with neuroendocrine and inflammatory activation. We hypothesize that neuroendocrine and inflammatory activation also associate with symptom severity and echocardiographic measurements in pediatric HF. Methods: Nineteen children with HF were divided into 3 symptom severity groups. Measurements were made of left ventricular (LV) ejection fraction, LV shortening fraction (LVSF), LV shortening fraction Z score (LVSFz), and LV end-systolic (LVSDz) and diastolic diameter Z scores. Blood levels of N-terminal prohormone brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor α, and soluble tumor necrosis factor receptor II were measured. Results: NT-proBNP and hsCRP were significantly elevated with more severe symptoms (P ≤ .003) and discriminated between clinical severity groups (volume under the receiver operating characteristic surface = 0.58 and 0.62, P = .007 and P = .002, respectively). NT-proBNP was negatively associated with LV ejection fraction, LVSF, and LVSFz (P ≤ .05) and positively associated with LVSDz (P < .001). High-sensitivity C-reactive protein was negatively associated with LVSF (P = .02) and positively associated with NT-proBNP (P = .03). Tumor necrosis factor α was negatively associated with LVSF and LVSFz (P ≤ .03) and positively associated with LVSDz and NT-proBNP (P ≤ .02). Soluble tumor necrosis factor receptor II was negatively associated with LVSFz (P = .03). Conclusions: Neuroendocrine and inflammatory activation are associated with more severe symptoms and worse cardiac characteristics in pediatric HF. Blood levels of these biomarkers could be used to better assess the severity of HF in children.

Original languageEnglish
Pages (from-to)527-533
Number of pages7
JournalAmerican Heart Journal
Volume155
Issue number3
DOIs
StatePublished - Mar 1 2008

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Brain Natriuretic Peptide
Heart Failure
C-Reactive Protein
Tumor Necrosis Factor Receptors
Stroke Volume
Tumor Necrosis Factor-alpha
Pediatrics
ROC Curve
Biomarkers
peptide P

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Associations between neurohormonal and inflammatory activation and heart failure in children. / Ratnasamy, Christopher; Kinnamon, Daniel D.; Lipshultz, Steven E; Rusconi, Paolo.

In: American Heart Journal, Vol. 155, No. 3, 01.03.2008, p. 527-533.

Research output: Contribution to journalArticle

Ratnasamy, Christopher ; Kinnamon, Daniel D. ; Lipshultz, Steven E ; Rusconi, Paolo. / Associations between neurohormonal and inflammatory activation and heart failure in children. In: American Heart Journal. 2008 ; Vol. 155, No. 3. pp. 527-533.
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AB - Background: Adult heart failure (HF) has been shown to be associated with neuroendocrine and inflammatory activation. We hypothesize that neuroendocrine and inflammatory activation also associate with symptom severity and echocardiographic measurements in pediatric HF. Methods: Nineteen children with HF were divided into 3 symptom severity groups. Measurements were made of left ventricular (LV) ejection fraction, LV shortening fraction (LVSF), LV shortening fraction Z score (LVSFz), and LV end-systolic (LVSDz) and diastolic diameter Z scores. Blood levels of N-terminal prohormone brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor α, and soluble tumor necrosis factor receptor II were measured. Results: NT-proBNP and hsCRP were significantly elevated with more severe symptoms (P ≤ .003) and discriminated between clinical severity groups (volume under the receiver operating characteristic surface = 0.58 and 0.62, P = .007 and P = .002, respectively). NT-proBNP was negatively associated with LV ejection fraction, LVSF, and LVSFz (P ≤ .05) and positively associated with LVSDz (P < .001). High-sensitivity C-reactive protein was negatively associated with LVSF (P = .02) and positively associated with NT-proBNP (P = .03). Tumor necrosis factor α was negatively associated with LVSF and LVSFz (P ≤ .03) and positively associated with LVSDz and NT-proBNP (P ≤ .02). Soluble tumor necrosis factor receptor II was negatively associated with LVSFz (P = .03). Conclusions: Neuroendocrine and inflammatory activation are associated with more severe symptoms and worse cardiac characteristics in pediatric HF. Blood levels of these biomarkers could be used to better assess the severity of HF in children.

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