21: BNP Levels Predict Outcome in Pediatric Heart Failure Patients: Post-Hoc Analysis of the Pediatric Carvedilol Trial

Plasma B-type natriuretic peptides in children with cardiovascular diseases

Natriuretic peptides (NP) are released from the heart in response to pressure and volume overload. The biologic properties of NPs include counterregulation of the rennin-angiotensin-aldosterone pathway and a decrease in sympathetic tone resulting in diuresis, natriuresis, and vasodilation. Natriuretic peptides help to maintain fluid balance and blood pressure in a healthy physiologic range. The B-type natriuretic peptide (BNP) and its N-terminal precursor (NTpBNP) have become important diagnostic biomarkers of cardiovascular diseases (CVDs) in adults. Although many studies suggest that BNP also is a reliable test for diagnosing significant CVDs in children, data are lacking on whether additional use of BNP increases diagnostic accuracy and predicts prognosis. This comprehensive review describes the utility of BNP and NTpBNP for various CVDs of the neonatal and pediatric age groups. Because BNP is not a stand-alone test, it should not replace history, physical examination, or clinical judgment, but it has a clear value in adding details to the whole story for children, thus enabling the front-line physicians to make a diagnosis, especially in the acute care setting.

Serum parameters and echocardiographic predictors of death or need for transplant in newborns, children, and young adults with heart failure

For children admitted with symptomatic heart failure (HF), the risk of death/need for transplantation (D/Tx) is high. Data from adult studies suggest serum measurements, such as percent lymphocytes, are valuable predictors of outcomes. The aim of this study was to identify risk factors for D/Tx in hospitalized pediatric patients with symptomatic HF. Retrospective analysis of children admitted to an academic center from January 1994 to June 2008 with clinical HF was undertaken. The most common cause of HF was dilated cardiomyopathy (58 of 99, 59%). Echocardiographic and serum measurements were collected from admission. Factors independently associated with risk of D/Tx were evaluated by a stepwise multivariate Cox regression model. There were 99 children with 139 hospitalizations. Median age at admission was 3 years (range 0 to 22). Mean systemic ventricular ejection fraction was 23% +/- 11. Risk of D/Tx per hospitalization was 60 of 139 (43%). In multivariate analysis, lymphocytopenia, lower ejection fraction, low serum sodium, and higher serum creatinine were independent predictors of D/Tx. These variables correctly predicted those subjects at risk of D/Tx in 82.1% of cases. Subgroup analysis found that brain natruretic peptide did not improve the model's accuracy markedly. In conclusion, serum measurements (percent lymphocytes, sodium, and creatinine) and echocardiographic assessment routinely obtained at admission are predictive of D/Tx in children hospitalized for HF. Significant lymphocytopenia was predictive of adverse outcomes.