Diagnostic accuracy and clinical relevance of brain natriuretic peptide assay in pediatric patients with congenital heart diseases

Cantinotti, Massimiliano; Vittorini, Simona; Storti, Simona; Prontera, Concetta; Murzi, Michele; Lucia, Vittoria De; Recla, Sabine; Assanta, Nadia; Giusti, Sandra; Murzi, Bruno; Bottone, U; Clerico, Aldo

doi:10.2459/jcm.0b013e32832c15fb

Cited by 20 publications

(19 citation statements)

References 31 publications

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“…In these studies BNP levels differentiated NYHA classes regardless the type of cardiac lesion [6] and showed a strong correlation with left ventricular outflow obstruction [33]. There was one study to include CoA patients, yet untreated, in a left pressure overload group which reported that BNP shows a good diagnostic accuracy in discriminating these patients from apparently healthy individuals [34]. Our study reports no difference in NT-pro-BNP levels between repaired CoA patients and controls.…”

Section: Neurohormonal and Immune Activation Late After Coa Repairmentioning

confidence: 72%

Neurohormonal activity and vascular properties late after aortic coarctation repair

Moutafi

Alissafi

Chamakou

et al. 2012

International Journal of Cardiology

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Section: Neurohormonal and Immune Activation Late After Coa Repairmentioning

confidence: 72%

Neurohormonal activity and vascular properties late after aortic coarctation repair

Moutafi

Alissafi

Chamakou

et al. 2012

International Journal of Cardiology

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“…[66][67][68] Many studies of BNP and NT-proBNP have been reported from the developing countries, in resource-limited settings. 10,38,59 The easy availability and its potential to complement echocardiography in the diagnosis of hsPDA or cardiac dysfunction in patients with bronchopulmonary dysplasia is likely to increase its usage in neonatal units, especially in resource-limited areas.…”

Section: Figurementioning

confidence: 99%

Diagnosing Significant PDA Using Natriuretic Peptides in Preterm Neonates: A Systematic Review

Kulkarni¹,

Gokulakrishnan²,

Price

et al. 2015

Pediatrics

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BACKGROUND AND OBJECTIVES: Echocardiogram is the gold standard for the diagnosis of hemodynamically significant patent ductus arteriosus (hsPDA) in preterm neonates. A simple blood assay for brain natriuretic peptide (BNP) or amino-terminal pro-B-type natriuretic peptide (NT-proBNP) may be useful in the diagnosis and management of hsPDA. Our objectives were to determine the diagnostic accuracy of BNP and NT-proBNP for hsPDA in preterm neonates and to explore heterogeneity by analyzing subgroups. METHODS:The systematic review was performed as recommended by the Cochrane Diagnostic Test Accuracy Working Group. Electronic databases, conference abstracts, and cross-references were searched. We included studies that evaluated BNP or NT-proBNP (index test) in preterm neonates with suspected hsPDA (participants) in comparison with echocardiogram (reference standard). A bivariate random effects model was used for meta-analysis, and summary receiver operating characteristic curves were generated.RESULTS: Ten BNP and 11 NT-proBNP studies were included. Studies varied by methodological quality, type of commercial assay, thresholds, age at testing, gestational age, and whether the assay was used to initiate medical or surgical therapy. Sensitivity and specificity for BNP at summary point were 88% and 92%, respectively, and for NT-proBNP they were 90% and 84%, respectively. CONCLUSIONS:The studies evaluating the diagnostic accuracy of BNP and NT-proBNP for hsPDA varied widely by assay characteristics (assay kit and threshold) and patient characteristics (gestational and chronological age); therefore, generalizability between centers is not possible. We recommend that BNP or NT-proBNP assays be locally validated for specific patient population and outcomes, to initiate therapy or follow response to therapy.

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“…The greatest limitation of this study was the limited heterogeneous population and retrospective nature of this review; however, the trend in the eight patients with contiguous data points through the first four months supports that our conclusions about the trend are true. The heterogeneity is demonstrated by the fact that the protocol would entail 14 samples over the first 12 months and the median data points per patient in this cohort were 5 , showing that the majority did not complete the entire protocol. With the median time to the initial value of nine days, the majority of these patients were either included from the beginning but did not complete it by the time the study terminated, but others were partially through the protocol when they entered the study.…”

Section: Study Limitationsmentioning

confidence: 95%

“…Utility has been difficult to establish due to the heterogeneity of CHD. Studies demonstrate significant variability of BNP due to the multiple combinations of volume and pressure perturbations in both right and left heart diseases . It has, however, demonstrated the ability to identify patients with a hemodynamically significant patent ductus arteriosus , correlate with the degree of left to right shunt and correlate with heart failure in single‐ventricle patients after stage 2 and stage 3 palliation .…”

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confidence: 99%

B‐type natriuretic peptide trends after pediatric heart transplantation

Sparks

Boston

Eghtesady

et al. 2014

Pediatric Transplantation

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BNP is increasingly utilized in the management of pediatric HT recipients. Performing a retrospective single-center chart review, we sought to describe BNP changes during the first year after HT and identify factors that affect its trend. After exclusion for rejection, 316 BNP levels from 50 patients were evaluated. BNP underwent an exponential decline 120 days after HT followed by a plateau. Log10 BNP decline strongly correlated with time (r = -0.70, p < 0.0001). Initial BNP was less in pretransplant VAD (p = 0.0016) and lower post-HT inotrope use (p = 0.0043). Infant recipients, IT >4 h, and those bridged medically were associated with higher plateau BNP. Multivariable logistic regression demonstrated IT >4 h independently predicted plateau BNP in the upper quartile (OR 7.1, p = 0.02). No significant change in BNP coincided with rejection (N = 6 patients) without severe hemodynamic compromise. BNP correlated modestly with right atrial pressure (r = 0.4652, p < 0.0001) and pulmonary capillary wedge pressure (r = 0.2660, p < 0.001), but poorly with echocardiogram (r = -0.18, p = 0.003). Trending BNP could help provide insight into how the graft recovers after HT and IT >4 h independently predicted higher plateau BNP and may reflect subtle changes in graft performance.

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Diagnostic accuracy and clinical relevance of brain natriuretic peptide assay in pediatric patients with congenital heart diseases

Abstract: BNP assay showed a good diagnostic accuracy in discriminating between healthy individuals and patients. Congenital heart disease with left ventricular pressure overload and biventricular volume overload has higher BNP values than that with right ventricular pressure overload.

Cited by 20 publications

References 31 publications

Neurohormonal activity and vascular properties late after aortic coarctation repair

Neurohormonal activity and vascular properties late after aortic coarctation repair

Diagnosing Significant PDA Using Natriuretic Peptides in Preterm Neonates: A Systematic Review

B‐type natriuretic peptide trends after pediatric heart transplantation

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