European Heart Journal Advance Access originally published online on February 8, 2006
European Heart Journal 2006 27(7):861-866; doi:10.1093/eurheartj/ehi773
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B-type natriuretic peptide in paediatric patients with congenital heart disease
Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Loschgestr. 15, D-91054 Erlangen, Germany
Received 24 June 2005; revised 13 December 2005; accepted 19 January 2006; online publish-ahead-of-print 8 February 2006.
* Corresponding author. Tel: +49 9131 8533118; fax: +49 9131 8535987. E-mail address: andreas.koch{at}kinder.imed.uni-erlangen.de
Aims To examine the diagnostic value of B-type natriuretic peptide (BNP) plasma concentration in congenital heart disease.
Methods and results BNP was measured in 288 consecutive patients (mean age 6.0±6.4 years) with left-to-right shunt, left or right heart obstruction, tetralogy of Fallot, functionally univentricular heart, or impaired left ventricular function and compared with age- and gender-specific normal values, and to haemodynamic and echocardiographic data. BNP increased with decreasing left ventricular shortening fraction (r=–0.80; P<0.001). In patients with left-to-right shunt, BNP was increased (mean SDS +1.64; P<0.001) and positively correlated (P<0.001) to shunt volume (r=0.66), systolic right ventricular pressure (r=0.69), mean pressure of the pulmonary artery (r=0.66), and pulmonary resistance (r=0.59). There was no correlation between BNP and invasive pressure gradient or extent of ventricular hypertrophy in patients with left or right heart obstruction. In patients with tetralogy of Fallot, BNP was not significantly increased. Patients with functionally univentricular heart had elevated BNP plasma levels (mean SDS +1.39; P<0.001) without decrease after volume unloading by cavopulmonary connection.
Conclusion In children with congenital heart defects, plasma BNP correlates closely to ventricular function. BNP plasma levels do not reflect directly the extent of ventricular pressure or volume work, but mirror the impairment of the loaded ventricles. Normal BNP cannot exclude pathology, but reflects a compensated status of the heart.
Key Words: BNP • Congenital heart disease • Ventricular function • Volume • Pressure • Resistance
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