Clinical Implications of Serial Serum N-Terminal Prohormone Brain Natriuretic Peptide Levels in the Prediction of Outcome in Children With Dilated Cardiomyopathy

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• 作者：Geena Kim ; Ok Jeong Lee ; I-Seok Kang ; Jinyoung Song ; June Huh
• 刊名：The American Journal of Cardiology
• 出版年：2013
• 出版时间：1 November, 2013
• 年：2013
• 卷：112
• 期：9
• 页码：1455-1460
• 全文大小：388 K

文摘

N-terminal prohormone brain natriuretic peptide (NT-proBNP) is known to be valuable as a prognostic marker for the management of heart failure. This study aimed to assess the serial changes of serum NT-proBNP levels as a prognostic factor for outcomes of pediatric dilated cardiomyopathy (DC). A retrospective study reviewed echocardiographic measurements and serum NT-proBNP levels obtained at the time of diagnosis, 3 and 6?months after diagnosis, and at the last follow-up in 68 children with DC. They were classified into 3 groups according to the last follow-up of the left ventricular (LV) function: group I (n?= 37) with LV fractional shortening (FS) ¡Ý25 % , group II (n?= 15) with 10 % ¡Ü LVFS < 25 % , and group III (n?= 16) with LVFS <10 % or cardiac death. The median age at diagnosis was 30?months and median duration of follow-up was 45?months (range 8 to 108?months). The origin of DC varied. Serial serum NT-proBNP levels showed statistically significant differences among the 3 groups. Although initial levels of serum NT-proBNP at diagnosis were not different from each other, group III maintained a higher NT-proBNP level throughout the duration of the follow-up. On multivariate Cox analysis, only the NT-proBNP level at 3?months was a significant predictor of an adverse outcome (hazard ratio 2.012, p?= 0.028). The percent changes of NT-proBNP from diagnosis were not significant. Patients with DC with a serum NT-proBNP level ¡Ý681?pg/ml at 3?months after diagnosis showed an increased risk of severe LV dysfunction or cardiac death (p <0.001, area under the curve?= 0.846). In conclusion, the level of NT-proBNP in serum at 3?months after diagnosis could predict an adverse outcome in pediatric DC and could be used as a guide for long-term treatment plans.