Effectiveness of serial increases in amino-terminal prob-type natriuretic peptide levels to indicate the need for mechanical circulatory support in children with acute decompensated heart failure

Derek T.H. Wong, Kristen George, Judith Wilson, Cedric Manlhiot, Brian W. McCrindle, Khosrow Adeli, Paul F. Kantor

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Abstract

We sought to determine prospectively whether serial assessment of the natriuretic peptide prohormone, amino-terminal proB-type natriuretic peptide (NTpro-BNP), correlated with clinical severity and outcomes in children hospitalized for acute decompensated heart failure (ADHF). Patients (>1 month of age) admitted from 2005 to 2007 with ADHF requiring intravenous vasoactive/diuretic therapy for ADHF were eligible. Serum NTpro-BNP levels were obtained within 24 hours of admission and at prespecified intervals, and clinical caregivers were blinded to these levels. End points included hospital discharge, death or cardiac transplantation, and care escalation including the need for mechanical circulatory support (MCS) was noted. Twenty-four patients were enrolled: 22 survived to hospital discharge and 2 died. Ten required MCS (of which 6 underwent cardiac transplantation). Two patients underwent transplantation without MCS. For the entire cohort, NTpro-BNP levels peaked at days 2 to 3 after admission, with a subsequent gradual decrease until discharge. However, for those who did require MCS, NTpro-BNP failed to decrease consistently until after MCS initiation. At discharge, NTpro-BNP levels were significantly decreased from admission levels but remained well above normal for all patients. Single-point NTpro-BNP levels on admission did not correlate with independently assessed clinical scores of heart failure severity or predict the need for MCS in this cohort. In conclusion, serial NTpro-BNP levels demonstrated an incremental trend after 48 hours in patients who went on to require MCS but decreased in all other patients and may therefore assist the decision to initiate or avoid MCS after admission for pediatric ADHF.

Original languageEnglish (US)
Pages (from-to)573-578
Number of pages6
JournalAmerican Journal of Cardiology
Volume107
Issue number4
DOIs
StatePublished - Feb 15 2011
Externally publishedYes

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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