Biomarker responses during mid-term mechanical cardiac support in children

J Heart Lung Transplant. 2008 Feb;27(2):150-7. doi: 10.1016/j.healun.2007.11.564.


Background: The purpose of this study was to determine the effect of mid-term mechanical circulatory support on the natriuretic hormone system in children and to assess whether such changes are associated with myocardial recovery.

Methods: Serial blood samples were collected from 19 children (median age 10.8 years, range 0.2 to 17.5 years), all supported with a pulsatile ventricular assist device (Berlin Heart EXCOR; median support time 55 days). Levels of NT-proBNP were analyzed before and 7 and 30 days after device implantation. In addition, we determined levels of mid-region proANP (MR-proANP) and BNP in 13 of the 19 children.

Results: The actuarial survival rate to discharge home was 84%. Two children could be weaned from the system, 14 reached heart transplantation, and 3 died during mechanical circulatory support. Serial measurements of NT-proBNP, BNP and MR-proANP showed a significant down-regulation of all three natriuretic peptides within the first week of support and a further decrease between Days 7 and 30. The lowest NT-proBNP level while on the device (250 pg/ml) was found in the child later weaned, who reached normal levels (71 pg/ml) within 12 weeks after weaning.

Conclusions: Extremely high levels of natriuretic peptides reflect the severity of myocardial failure before device implantation. During mechanical support, the decline of natriuretic peptides appears to be a helpful additional tool in the pre-selection of potential weaning candidates.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Biomarkers / blood
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Cohort Studies
  • Equipment Failure
  • Female
  • Heart Defects, Congenital / blood
  • Heart Defects, Congenital / mortality*
  • Heart Defects, Congenital / surgery*
  • Heart Transplantation
  • Heart-Assist Devices*
  • Humans
  • Infant
  • Male
  • Natriuretic Peptide, Brain / blood*
  • Peptide Fragments / blood*
  • Probability
  • Prognosis
  • Reference Values
  • Sensitivity and Specificity
  • Statistics, Nonparametric
  • Survival Rate
  • Waiting Lists


  • Biomarkers
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain