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European Heart Journal 1996 17(11):1737-1746;
Copyright © 1996 by the European Society of Cardiology.
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© 1996 The European Society of Cardiology

Serum N-terminal proatrial natriuretic factor in children with congenital heart disease

H. Holmström, E. Thaulow, O. Stokke*, H. Lindberg{dagger} and C. Hall{ddagger}

Department of Pediatrics, National Hospital (Rikshospitalet) Oslo, Norway
*Institute of Clinical Biochemistry, National Hospital (Rikshospitalet) Oslo, Norway
{dagger}Thoracic and Cardiovascular Surgery Unit, National Hospital (Rikshospitalet) Oslo, Norway
{ddagger}Institute for Surgical Research, National Hospital (Rikshospitalet) Oslo, Norway

Received 8 February 1996; accepted 14 February 1996.

Correspondence: Henrik Holmström, Barnehjerteseksjonen, Rikshospitalet (National Hospital), N-0027 Oslo, Norway

Abstract

An objective and simple method of establishing and grading heart failure in children is needed. The N-terminal of the atrial natriuretic factor prohormone, called proANF, is stable in vitro, relatively easy to measure and has been demonstrated as a clinically useful marker of heartfailure in adults.

We measured proANF in 62 children with congenital heart disease and in 62 age-matched controls, in order to examine the relationship of proANF to different clinical and haemodynamic parameters. Echo Doppler cardiography was performed in all children, and 29 also underwent cardiac catheterization. The children were classified for volume and pressure load in each cardiac chamber, for shunt size and for signs of heart failure.

In paediatric patients without cardiac or renal disease, median proANF was 384 pmol . 1–1. In children with congenital heart disease, median proANF was 904 (200–5320) pmol . 1–1 (P<0.001). The three groups with the highest proANF levels were children with documented high atrial pressure (median proANF 1885 pmol . 1–1), a large left to right shunt (median proANF 1565 pmol . 1–1) and moderate or severe heart failure (median proANF 1305 pmol. 1–1). Furthermore, the proANF level correlated negatively with age and glomerular filtration rate.

We conclude that elevation of the proANF level is related to atrial pressures, heart failureand a high pulmonary to systemic flow ratio. These findings make proANF a potential new diagnostic tool in heart disease in children.

Key Words: Atrial natriuretic factor • congenital heart disease • children • dignosis • heart failure • proatrial natriuretic factor


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[Abstract] [Full Text] [PDF]


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