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

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

Research output: Contribution to journalArticle

38 Citations (Scopus)

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
Pages (from-to)776-783
Number of pages8
JournalAmerican Heart Journal
Volume160
Issue number4
DOIs
StatePublished - Oct 1 2010

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Ventricular Remodeling
Brain Natriuretic Peptide
Left Ventricular Function
Heart Failure
Hormones
Serum
Dilated Cardiomyopathy
ROC Curve
Stroke Volume
Linear Models
Logistic Models

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

Cite this

Serial measurements of serum NT-proBNP as markers of left ventricular systolic function and remodeling in children with heart failure. / Rusconi, Paolo; Ludwig, David; Ratnasamy, Christopher; Mas, Robert; Harmon, William G.; Colan, Steven D.; Lipshultz, Steven E.

In: American Heart Journal, Vol. 160, No. 4, 01.10.2010, p. 776-783.

Research output: Contribution to journalArticle

Rusconi, Paolo ; Ludwig, David ; Ratnasamy, Christopher ; Mas, Robert ; Harmon, William G. ; Colan, Steven D. ; Lipshultz, Steven E. / Serial measurements of serum NT-proBNP as markers of left ventricular systolic function and remodeling in children with heart failure. In: American Heart Journal. 2010 ; Vol. 160, No. 4. pp. 776-783.
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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.",
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AU - Colan, Steven D.

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N2 - 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.

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