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Clinical Trial
. 2014 Jun;35(5):879-87.
doi: 10.1007/s00246-014-0872-z. Epub 2014 Feb 13.

Factors Associated With Serum B-type Natriuretic Peptide in Infants With Single Ventricles

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Free PMC article
Clinical Trial

Factors Associated With Serum B-type Natriuretic Peptide in Infants With Single Ventricles

Ryan J Butts et al. Pediatr Cardiol. .
Free PMC article

Abstract

Data regarding the value of B-type natriuretic peptide (BNP) measurements in infants with a single-ventricle (SV) physiology are lacking. This analysis aimed to describe the BNP level changes in infants with an SV physiology before and after superior cavopulmonary connection (SCPC) surgery. Levels of BNP were measured by a core laboratory before SCPC (at 5.0 ± 1.6 months) and at the age of 14 months during a multicenter trial of angiotensin-converting enzyme inhibition therapy for infants with SV. Multivariable longitudinal analysis was used to model the associations between BNP levels and three sets of grouped variables (echocardiography, catheterization, growth). Multivariable analysis was performed to assess associations with patient characteristics at both visits. Associations between BNP levels and neurodevelopmental variables were investigated at the 14 month visit because neurodevelopmental assessment was performed only at this visit. The BNP level was significantly higher before SCPC (n = 173) than at the age of 14 months (n = 134). The respective median levels were 80.8 pg/ml (interquartile range [IQR], 35-187 pg/ml) and 34.5 pg/ml (IQR, 17-67 pg/ml) (p < 0.01). A BNP level higher than 100 pg/ml was present in 72 subjects (42 %) before SCPC and in 21 subjects (16 %) at the age of 14 months. In the 117 patients who had BNP measurements at both visits, the median BNP level decreased 32 pg/ml (IQR, 1-79 pg/ml) (p < 0.01). In the longitudinal multivariable analysis, higher BNP levels were associated with a higher end-systolic volume z-score (p = 0.01), a greater degree of atrioventricular (AV) valve regurgitation (p < 0.01), a lower weight z-score (p < 0.01), and a lower length z-score (p = 0.02). In multivariable analyses, a higher BNP level at the age of 14 months was associated with arrhythmia after SCPC surgery (p < 0.01), a prior Norwood procedure (p < 0.01), a longer hospital stay after SCPC surgery (p = 0.04), and a lower Bayley psychomotor developmental index (p = 0.02). The levels of BNP decreases in infants with SV from the pre-SCPC visit to the age of 14 months. A higher BNP level is associated with increased ventricular dilation in systole, increased AV valve regurgitation, impaired growth, and poorer neurodevelopmental outcomes. Therefore, BNP level may be a useful seromarker for identifying infants with SV at risk for worse outcomes.

Conflict of interest statement

The authors have no conflicts to disclose.

Figures

Figure 1
Figure 1
Log-transformed brain natriuretic peptide (logBNP, Fig1A) was significantly higher in the pre-superior cavopulmonary connection (Pre-SCPC) time period (5.0 ± 1.6 months) compared to the 14 month visit (4.4 ± 1.3 vs. 3.5 ± 1.7, p<0.01). Raw median values of BNP were 80.8 pg/mL (IQR, 35–187 pg/mL, n=173) and 34.5pg/mL (IQR 17–67 pg/mL, n=134, p<0.01) at the pre-SCPC and 14-month time points, respectively. Raw BNP values are presented at Fig 1B (6 Pre-SCPC outlying values, between 1100 and 4100 pg/mL, are excluded to improve resolution)
Figure 1
Figure 1
Log-transformed brain natriuretic peptide (logBNP, Fig1A) was significantly higher in the pre-superior cavopulmonary connection (Pre-SCPC) time period (5.0 ± 1.6 months) compared to the 14 month visit (4.4 ± 1.3 vs. 3.5 ± 1.7, p<0.01). Raw median values of BNP were 80.8 pg/mL (IQR, 35–187 pg/mL, n=173) and 34.5pg/mL (IQR 17–67 pg/mL, n=134, p<0.01) at the pre-SCPC and 14-month time points, respectively. Raw BNP values are presented at Fig 1B (6 Pre-SCPC outlying values, between 1100 and 4100 pg/mL, are excluded to improve resolution)

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