B-type natriuretic peptide and amino-terminal pro-B-type natriuretic peptide in pediatric patients with pulmonary arterial hypertension

Congenit Heart Dis. 2012 May-Jun;7(3):259-67. doi: 10.1111/j.1747-0803.2011.00620.x. Epub 2012 Feb 10.


Objectives: B-type natriuretic peptide (BNP) and the amino-terminal fragment (NTproBNP) correlate with clinical variables, but have not been simultaneously studied in a large number of pediatric patients with pulmonary arterial hypertension (PAH). The purpose of our investigation was to compare BNP and NTproBNP with clinical indicators of disease in a pediatric PAH population for which biomarkers are much needed.

Design: We retrospectively compared BNP and NTproBNP levels with exercise capacity, echocardiographic data, and hemodynamics in PAH patients under 21 years old. Two hundred sixty-three blood samples from 88 pediatric PAH patients were obtained, with BNP and NTproBNP drawn at the same time.

Results: There was a correlation between BNP and NTproBNP with mean pulmonary arterial pressure/mean systemic arterial pressure ratio (r= 0.40, P < .01; r= 0.45, P < .01; respectively), mean right atrial pressure (r= 0.48, P < .01; r= 0.48, P < .01), and tricuspid regurgitant velocity (r= 0.36, P < .01; r= 0.41, P < .01). BNP and NTproBNP are associated with 6-minute walk distance, mean pulmonary arterial pressure, mean pulmonary arterial pressure/mean systemic arterial pressure ratio, mean right atrial pressure, pulmonary vascular resistance index, and tricuspid regurgitant velocity when investigated longitudinally. On the average, a 1-unit increase in log BNP or NTproBNP was associated with 4.5 units × m(2) or 3.4 units × m(2) increase in pulmonary vascular resistance index, respectively. There was a strong correlation between log BNP and log NTproBNP measurements (r= 0.87, P < .01).

Conclusion: In pediatric PAH, BNP and NTProBNP are strongly correlated and predict changes in clinical variables and hemodynamics. In a cross-sectional analysis, NTproBNP correlated with echocardiographic and exercise data better than BNP; NTproBNP showed less within patient variability over time; therefore, NTproBNP can add additional information toward predicting these clinical measurements.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Age Factors
  • Biomarkers / blood
  • Cardiac Catheterization
  • Child
  • Child, Preschool
  • Colorado
  • Cross-Sectional Studies
  • Echocardiography
  • Exercise Test
  • Exercise Tolerance
  • Familial Primary Pulmonary Hypertension
  • Female
  • Hemodynamics
  • Humans
  • Hypertension, Pulmonary / blood*
  • Hypertension, Pulmonary / diagnosis
  • Hypertension, Pulmonary / physiopathology
  • Linear Models
  • Male
  • Natriuretic Peptide, Brain / blood*
  • Peptide Fragments / blood*
  • Predictive Value of Tests
  • Prognosis
  • Retrospective Studies
  • Tricuspid Valve / physiopathology


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