Serial measurements of serum NT-proBNP as markers of left ventricular systolic function and remodeling in children with heart failure

Paolo G. Rusconi, David A. Ludwig, Christopher Ratnasamy, Robert Mas, William G. Harmon, Steven D. Colan, Steven E. Lipshultz

Research output: Contribution to journalArticle

38 Scopus citations

Abstract

Background: Increasing serum levels of N-terminal pro-hormone brain natriuretic peptide (NT-proBNP) are associated with worsening heart failure (HF) in adults. We determined whether changes in NT-proBNP level are associated with changes in symptoms and left ventricular (LV) systolic function and remodeling in children with HF secondary to dilated cardiomyopathy. Methods: We retrospectively examined associations between serum NT-proBNP levels and NYHA/Ross functional class, LV systolic and diastolic diameter (LVSD-z and LVDD-z), LV ejection fraction (LVEF), and LV shortening fraction (LVSF-z) using generalized linear mixed models. Fluctuation in functional class of subjects was also modeled using logistic regression and receiver operating characteristic (ROC) curves. Results: In 36 children (14 males), a 10-fold increase in NT-proBNP serum levels was associated (P < .001) with a 9.8% decrease in LVEF, a 3.25-unit drop in LVSF-z, a 1.53-unit increase in LVDD-z, a 2.64-unit increase in LVSD-z, and an increased odds of being in functional class III/IV (OR 85.5; 95% CI, 10.9 to 671.0). An NT-proBNP level greater than 1000 pg/mL identified children constantly or intermittently in functional class III-IV with 95% sensitivity and 80% specificity. The reliability of a single NT-proBNP value was 0.61, but the means for two and three NT-proBNP values were 0.76 and 0.82, respectively. Conclusions: In children with HF, NT-proBNP is associated with cardiac symptoms and indices of LV systolic dysfunction and remodeling. NT-proBNP >1000 pg/mL identifies highly symptomatic children. Within subject serial measurements of NT-proBNP are needed for a reliable and accurate determination of disease status and/or course.

Original languageEnglish (US)
Pages (from-to)776-783
Number of pages8
JournalAmerican Heart Journal
Volume160
Issue number4
DOIs
StatePublished - Oct 2010

Keywords

  • heart failure
  • HF
  • left ventricular
  • left ventricular diastolic diameter relative to body surface area z-score
  • left ventricular ejection fraction
  • left ventricular shortening fraction relative to age z-score
  • left ventricular systolic diameter relative to body surface area z-score
  • LV
  • LVDD-z
  • LVEF
  • LVSD-z
  • LVSF-z
  • N-terminal pro-hormone brain natriuretic peptide
  • New York Heart Association
  • NT-proBNP
  • NYHA
  • receiver operating characteristics
  • ROC

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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