Journal Article

Usefulness of Serial N-terminal Pro-B-type Natriuretic Peptide Measurements to Predict Cardiac Death in Acute and Chronic Dilated Cardiomyopathy in Children

Dalinghaus, Michiel, Tanke, Ronald B., Backx, Ad P.C.M., ten Harkel, Arend D.J., du Marchie Sarvaas, Gideon J., Boersma, Eric, den Boer, Susanna L., Rizopoulos, Dimitris, Helbing, Willem A., van Iperen, Gabriëlle G., Rammeloo, Lukas A.J.

2016

Overview

N-terminal pro-B-type natriuretic peptide (NT-proBNP) is an important predictor of outcome in adults with heart failure. In children with heart failure secondary to dilated cardiomyopathy (DC) markers that reliably predict disease progression and outcome during follow-up are scarce. We investigated whether serial NT-proBNP measurements were predictive for outcome in children with DC. All available NT-proBNP measurements in children with DC were analyzed. Linear mixed-effect models and Cox regression were used to analyze the predictive value of NT-proBNP on the end point of cardiac death (death, heart transplantation, or mechanical circulatory support). During 7 years, 115 patients were included. At diagnosis, median NT-proBNP was high and not predictive for outcome. At any time during follow-up, a twofold higher NT-proBNP resulted in a 2.9 times higher risk in the first year (p <0.001) and a 1.8 times higher risk thereafter (p <0.001). Furthermore, at any time, the slope of log10(NT-proBNP) was significantly predictive for the risk of an end point (0 to 30 days hazard ratio [HR] 3.5, >30 days HR 2.9; >1 year HR 6.4). In patients with idiopathic DC (IDC) at 30 days after diagnosis, NT-proBNP ≥7,990 pg/ml showed a 1- and 2-year event-free survival of 79% and 71% and >1 year after diagnosis NT-proBNP ≥924 pg/ml showed a 2- and 5-year event-free survival of 50% and 40%, whereas below both thresholds event-free survival was 100%. In non-IDC, these thresholds were not predictive for outcome. In conclusion, NT-proBNP at any time during follow-up and its change over time were significantly predictive for the risk of cardiac death in children with DC. In children with IDC >1 year after diagnosis, NT-proBNP >924 pg/ml identified a subgroup with a poor outcome.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Acute Disease / Adolescent / Age / Biomarkers - blood / Cardiomyopathy / Cardiomyopathy, Dilated - blood / Cardiomyopathy, Dilated - mortality / Cardiovascular / Child / Child, Preschool / Chronic Disease / Confidence intervals / Death, Sudden, Cardiac - epidemiology / Female / Follow-Up Studies / Heart failure / Humans / Infant / Infant, Newborn / Male / Medical prognosis / Mortality / Natriuretic Peptide, Brain - blood / Netherlands - epidemiology / Patients / Peptide Fragments - blood / Peptides / Prognosis / Retrospective Studies / Risk Assessment / Risk Factors / Rodents / Statistical analysis / Studies / Survival Rate - trends / Transplants & implants