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Concentrations of brain natriuretic peptide in the plasma predicts outcomes of treatment of children with decompensated heart failure admitted to the Intensive Care unit

Published online by Cambridge University Press:  18 June 2007

Lin-Hua Tan ,
John L. Jefferies ,
Jian-Feng Liang ,
Susan W. Denfield ,
William J. Dreyer ,
Antonio R. Mott ,
Michelle A. Grenier ,
Heather A. Dickerson ,
Jack F. Price  and
Jeffrey A. Towbin
...Show all authors
Lin-Hua Tan
Affiliation:
Department of Surgical Intensive Care Unit, Children’s Hospital College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
John L. Jefferies
Affiliation:
Division of Advanced Heart Failure, Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, Texas, United States of America Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Jian-Feng Liang
Affiliation:
Department of Surgical Intensive Care Unit, Children’s Hospital College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
Susan W. Denfield
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
William J. Dreyer
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Antonio R. Mott
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Michelle A. Grenier
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Heather A. Dickerson
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Jack F. Price
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Jeffrey A. Towbin
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Ching-Nan Ou
Affiliation:
Department of Pathology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Anthony C. Chang*
Affiliation:
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
*
Correspondence to: Anthony C. Chang, MD, Director, Children’s Heart Institute, Children’s Hospital of Orange County, 455 S. Main Street, Orange, CA 92868, USA. Tel: +1 714 221 5500; Fax: +1 714 221 5515; E-mail: [email protected]
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Abstract

Objectives

It is known that levels of brain natriuretic peptide predict outcomes of treatment for adults with decompensated heart failure. We hypothesized that it could predict outcomes in children with this condition.

Methods

We divided retrospectively 82 patients with serial measurements of brain natriuretic peptide into 3 groups: those who survived and did not need readmission within less than 60 days; those who survived but needed readmission within less than 60 days; and those who died in hospital or within less than 60 days. Initial and final levels of the peptide correlated with adverse outcomes.

Results

The percent change in level of the peptide was minus 78 percent, minus 38 percent, and 138 percent in the readmission-free group, the readmitted, and nonsurviving groups, respectively. Final levels were significantly lower in the readmission-free group than in the readmitted and nonsurviving groups (p equals 0.013 and p is less than 0.00001, respectively) and in the readmitted group than in the nonsurvivors (p equals 0.013). On univariate analysis, the final level, the change in level, and the percentage change in level significantly predicted outcomes (p equals 0.0002, 0.0072 and 0.0005, respectively). On multivariate analysis, only the final level of the peptide significantly predicted outcomes (p equals 0.01).

Conclusions

A final level of brain natriuretic peptide of greater than or equal to 760 picograms per millilitre strongly predicted an adverse outcome. Patients with higher final levels may be at higher risk of death and readmission, suggesting that this variable effectively predicts the response to treatment and prognosis in children with heart failure.

Keywords

Heart diseaseneurohormonal markersprognosispaediatrics
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Issue 4 , August 2007 , pp. 397 - 406
Copyright
Copyright © Cambridge University Press 2007

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References

1. Cowie, MR, Mosterd, A, Wood, DA, et al. . The epidemiology of heart failure. Eur Heart J 1997; 18: 208–225.CrossRefGoogle ScholarPubMed
2. Reis, SE, Holubkov, R, Edmundowicz, D, et al. . Treatment of patients admitted to the hospital with congestive heart failure: specialty-related disparities in practice patterns and outcomes. J Am Coll Cardiol 1997; 30: 733–738.Google Scholar
3. Hoch, M, Netz, H. Heart failure in children. Thorac Cardiovasc Surg 2005; 53 (Suppl 2): S129–S134.CrossRefGoogle Scholar
4. Kay, JD, Colan, SD, JrGraham, TP. Congestive heart failure in children. Am Heart J 2001; 142: 923–928.Google Scholar
5. Ferencz, C, Rubin, JD, McCarter, RJ, et al. . Congenital heart disease: prevalence at livebirth. The Baltimore-Washington Infant Study. Am J Epidemiol 1985; 121: 31–36.CrossRefGoogle ScholarPubMed
6. Philbin, EF, DiSalvo, TG. Managed care for congestive heart failure: influence of payer status on process of care, resource utilization, and short-term outcomes. Am Heart J 1998; 136: 553–561.CrossRefGoogle ScholarPubMed
7. Ciszewski, A, Bilinska, ZT, Lubiszewska, B, et al. . Dilated cardiomyopathy in children and adolescents. Diagnostic problems, clinical course and prognosis. Kardiol Pol 1991; 35: 354–359.Google Scholar
8. Kossovsky, MP, Sarasin, FP, Perneger, TV, Chopard, P, Sigaud, P, Gaspoz, J. Unplanned readmissions of patients with congestive heart failure: do they reflect in-hospital quality of care or patient characteristics? Am J Med 2000; 109: 386–390.CrossRefGoogle ScholarPubMed
9. Tsutamoto, T, Wada, A, Maeda, K, et al. . Attenuation of compensation of endogenous cardiac natriuretic peptide system in chronic heart failure: prognostic role of plasma brain natriuretic peptide concentration in patients with chronic symptomatic left ventricular dysfunction. Circulation 1997; 96: 509–516.CrossRefGoogle ScholarPubMed
10. Hama, N, Itoh, H, Shirakami, G, et al. . Rapid ventricular induction of brain natriuretic peptide gene expression in experimental acute myocardial infarction. Circulation 1995; 92: 1558–1564.CrossRefGoogle ScholarPubMed
11. Maeda, K, Tsutamoto, T, Wada, A, et al. . High levels of plasma brain natriuretic peptide and interleukin-6 after optimized treatment for heart failure are independent risk factors for morbidity and mortality in patients with congestive heart failure. J Am Coll Cardiol 2000; 36: 1587–1593.Google Scholar
12. Muders, F, Kromer, EP, Griese, DP, et al. . Evaluation of plasma natriuretic peptides as markers for left ventricular dysfunction. Am Heart J 1997; 134: 442–449.CrossRefGoogle ScholarPubMed
13. Yasue, H, Yoshimura, M, Sumida, H, et al. . Localization and mechanism of secretion of brain natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure. Circulation 1994; 90: 195–203.CrossRefGoogle ScholarPubMed
14. Cowley, CG, Bradley, JD, Shaddy, RE. Brain natriuretic peptide levels in congenital heart disease. Pediatr Cardiol 2004; 25: 336–340.CrossRefGoogle ScholarPubMed
15. Sodian, R, Loebe, M, Schmitt, C, et al. . Decreased plasma concentration of brain natriuretic peptide as a potential indicator of cardiac recovery in patients supported by mechanical circulatory assist systems. J Am Coll Cardiol 2001; 38: 1942–1949.CrossRefGoogle ScholarPubMed
16. Bettencourt, P, Frioes, F, Azevedo, A, et al. . Prognostic information provided by serial measurements of brain natriuretic peptide in heart failure. Int J Cardiol 2004; 93: 45–48.CrossRefGoogle ScholarPubMed
17. Lubien, E, DeMaria, A, Krishnaswamy, P, et al. . Utility of B-natriuretic peptide in detecting diastolic dysfunction: comparison with Doppler velocity recordings. Circulation 2002; 105: 595–601.CrossRefGoogle ScholarPubMed
18. Williams, SG, Ng, LL, O’Brien, RJ, Taylor, S, Li, YF, Tan, LB. Comparison of plasma N-brain natriuretic peptide, peak oxygen consumption, and left ventricular ejection fraction for severity of chronic heart failure. Am J Cardiol 2004; 93: 1560–1571.CrossRefGoogle ScholarPubMed
19. Troughton, RW, Frampton, CM, Yandle, TG, Espiner, EA, Nicholls, MG, Richards, AM. Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations. Lancet 2000; 355: 1126–1130.CrossRefGoogle ScholarPubMed
20. Murdoch, DR, McDonagh, TA, Byrne, J, et al. . Titration of vasodilator therapy in chronic heart failure according to plasma brain natriuretic peptide concentration: randomized comparison of the hemodynamic and neuroendocrine effects of tailored versus empirical therapy. Am Heart J 1999; 138: 1126–1132.CrossRefGoogle ScholarPubMed
21. Ross, RD, Bollinger, RO, Pinsky, WW. Grading the severity of congestive heart failure in infants. Pediatr Cardiol 1992; 13: 72–75.CrossRefGoogle ScholarPubMed
22. Reithmann, C, Reber, D, Kozlik-Feldmann, R, et al. . A post-receptor defect of adenylyl cyclase in severely failing myocardium from children with congenital heart disease. Eur J Pharmacol 1997; 330: 79–86.CrossRefGoogle ScholarPubMed
23. Laer, S, Mir, TS, Behn, F, et al. . Carvedilol therapy in children with congestive heart failure: a study investigating clinical and pharmacokinetic parameters. Am Heart J 2002; 143: 916–922.CrossRefGoogle ScholarPubMed
24. Jefferies, JL, Chang, AC. The neurohormonal axis and biochemical markers of heart failure. Cardiol Young 2005; 15: 333–344.CrossRefGoogle ScholarPubMed
25. Francis, GS, Benedict, C, Johnstone, DE, et al. . Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure. A substudy of the Studies of Left Ventricular Dysfunction (SOLVD). Circulation 1990; 82: 1724–1729.CrossRefGoogle ScholarPubMed
26. Remes, J, Tikkanen, I, Fyhrquist, F, Pyorala, K. Neuroendocrine activity in untreated heart failure. Br Heart J 1991; 65: 249–255.CrossRefGoogle ScholarPubMed
27. Swedberg, K, Eneroth, P, Kjekshus, J, Wilhelmsen, L. Hormones regulating cardiovascular function in patients with severe congestive heart failure and their relation to mortality. CONSENSUS Trial Study Group. Circulation 1990; 82: 1730–1736.Google Scholar
28. Tsutamoto, T, Hisanaga, T, Fukai, D, et al. . Prognostic value of plasma soluble intercellular adhesion molecule-1 and endothelin-1 concentration in patients with chronic congestive heart failure. Am J Cardiol 1995; 76: 803–808.CrossRefGoogle ScholarPubMed
29. Murdoch, DR, Byrne, J, Morton, JJ, et al. . Brain natriuretic peptide is stable in whole blood and can be measured using a simple rapid assay: implications for clinical practice. Heart 1997; 78: 594–597.CrossRefGoogle ScholarPubMed
30. Klinge, R, Hystad, M, Kjekshus, J, et al. . An experimental study of cardiac natriuretic peptides as markers of development of congestive heart failure. Scand J Clin Lab Invest 1998; 58: 683–691.CrossRefGoogle ScholarPubMed
31. Kazanegra, R, Cheng, V, Garcia, A, et al. . A rapid test for brain natriuretic peptide correlates with falling wedge pressures in patients treated for decompensated heart failure: a pilot study. J Card Fail 2001; 7: 21–29.CrossRefGoogle ScholarPubMed
32. Johnson, W, Omland, T, Hall, C, et al. . Neurohormonal activation rapidly decreases after intravenous therapy with diuretics and vasodilators for class IV heart failure. J Am Coll Cardiol 2002; 39: 1623–1629.CrossRefGoogle ScholarPubMed
33. Cheng, V, Kazanagra, R, Garcia, A, et al. . A rapid bedside test for brain peptide predicts treatment outcomes in patients admitted for decompensated heart failure: a pilot study. J Am Coll Cardiol 2001; 37: 386–391.CrossRefGoogle ScholarPubMed
34. Bettencourt, P, Ferreira, S, Azevedo, A, Ferreira, A. Preliminary data on the potential usefulness of brain natriuretic peptide levels in predicting outcome after hospital discharge in patients with heart failure. Am J Med 2002; 113: 215–219.CrossRefGoogle ScholarPubMed
35. Logeart, D, Thabut, G, Jourdain, P, et al. . Predischarge brain natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure. J Am Coll Cardiol 2004; 43: 635–641.CrossRefGoogle ScholarPubMed
36. Law, YM, Keller, BB, Feingold, BM, Boyle, GJ. Usefulness of plasma brain natriuretic peptide to identify ventricular dysfunction in pediatric and adult patients with congenital heart disease. Am J Cardiol 2005; 95: 474–478.CrossRefGoogle ScholarPubMed
37. Maisel, AS, Krishnaswamy, P, Nowak, RM, et al. . Rapid measurement of brain natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002; 347: 161–167.CrossRefGoogle ScholarPubMed
38. Mir, TS, Marohn, S, Laer, S, Eiselt, M, Grollmus, O, Weil, J. Plasma concentrations of N-terminal pro-brain natriuretic peptide in control children from the neonatal to adolescent period and in children with congestive heart failure. Pediatrics 2002; 110: e76.Google Scholar
39. Koch, A, Singer, H. Normal values of B type natriuretic peptide in infants, children, and adolescents. Heart 2003; 89: 875–878.CrossRefGoogle ScholarPubMed
40. Miller, WL, JrBurnett, JC, Hartman, KA, Henle, MP, Burritt, MF, Jaffe, AS. Lower rather than higher levels of brain natriuretic peptides (NT-pro-BNP and BNP) predict short-term mortality in endstage heart failure patients treated with nesiritide. Am J Cardiol 2005; 96: 837–841.CrossRefGoogle ScholarPubMed