Usefulness of B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide as biomarkers for heart failure in young children with single ventricle congenital heart disease

EvidenceUpdates, 2012

Usefulness of B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide as biomarkers for heart failure in young children with single ventricle congenital heart disease.
Abstract Children with single ventricle (SV) physiology have increased ventricular work and are at risk of heart failure (HF).
However, a HF diagnosis is especially difficult, because few objective measures of HF have been validated in this cohort.
We have previously shown that plasma B-type natriuretic peptide (BNP) levels are sensitive and specific for detecting HF in a small, heterogeneous SV cohort.
The aim of the present study was to define the effect of SV morphology and stage of palliation on the correlation between BNP and HF.
We also examined the utility of N-terminal pro-BNP (NT-proBNP), a more stable product of pre-BNP processing, as a biomarker of HF in these patients.
The association of BNP or NT-proBNP with HF was assessed using logistic regression analysis and receiver operating characteristic curves.
A doubling of BNP was associated with an odds ratio for HF of 2.20 (95% confidence interval 1.36 to 3.55, p = 0.001) with a c-statistic > 75%, yielding a detection threshold of ≥ 45 pg/ml.
This threshold was preserved when patients were stratified by the right ventricular morphology or stage of surgical palliation.
Similarly, a doubling of NT-proBNP was associated with an odds ratio for HF of 1.92 (95% confidence interval 1.17 to 3.14, p = 0.009).