Cardiac biomarkers in pediatric heart disease: A state of art review

Abstract

Every year there are more than 11000 hospitalizations related to heart failure in children resulting in significant morbidity and mortality. Over the last two decades, our understanding, diagnosis and management of pediatric heart failure is evolving but our ability to prognosticate outcomes in pediatric heart acute heart failure is extremely limited due to lack of data. In adult heart failure patients, the role of cardiac biomarkers has exponentially increased over the last two decades. Current guidelines for management of heart failure emphasize the role of cardiac biomarkers in diagnosis, management and prognostication of heart failure. It is also noteworthy that these biomarkers reflect important biological processes that also open up the possibility of therapeutic targets. There is however, a significant gap present in the pediatric population with regards to biomarkers in pediatric heart failure. Here, we seek to review available data regarding cardiac biomarkers in the pediatric population and also explore some of the emerging biomarkers from adult literature that may be pertinent to pediatric heart failure.

Platelet activation markers in children with congenital heart disease associated with pulmonary arterial hypertension

“…Despite increasing number of studies about BNP and NTproBNP in relation to pediatric PAH mortality, there are some pitfalls in evaluating these markers in clinical practice of pediatric patients with CHD. Levels of BNP or NTproBNP could easily change with age, gender, type of CHD and severity of left‐to‐right shunt . Variations of normative levels in these markers limits the usefulness of these markers in the clinical setting.…”

“…33 Van Albada et al 33 gender, type of CHD and severity of left-to-right shunt. 34 Variations of normative levels in these markers limits the usefulness of these markers in the clinical setting.…”

Correlation between NT pro-b-type Natriuretic peptide and left ventricular ejection fraction in children presenting with Dyspnea – a prospective cohort study

“…These elevations are especially seen with diseases that causes left ventricular volume overload when compared to right ventricular volume or pressure overload. Further more, when comparing pediatric populations with complex CHD vs simple cardiac defects (ASD, VSD or PDA), on average, complex defects tend to have higher concentrations [8].…”

Relevance of the Cardiac Biomarkers in Children with Heart Disease Admitted for Severe Cardiac Pathology

“…The implication of BNP and NT-pro BNP in congenital heart disease regarding the diagnose and the clinical decision making was not completely defined, but it was supposed that these biomarkers are of clinical importance because of the implication with proven usefulness in acquired heart disease, and also due to the simplicity of assesment. When comparing children with simple heart disease, such as ASD, VSD, PDA, with complex heart disease, in the complex heart disease, higher concentrations of NT-proBNP tend to be found [24]. In Tetralogy of Fallot, after surgical repair, the right ventricle starts to dylate due to pulmonary insufficiency, needing a valve implantation.…”