Hostname: page-component-848d4c4894-nr4z6 Total loading time: 0 Render date: 2024-06-01T07:06:27.339Z Has data issue: false hasContentIssue false
  • English
  • Français

N-terminal pro-B-type-natriuretic peptide as a screening tool for pulmonary hypertension in the paediatric population

Part of: Atrial Septal Defect (ASD) Echocardiography Interventional Cardiology

Published online by Cambridge University Press:  02 March 2021

Soham Dasgupta Open the ORCID record for Soham Dasgupta [Opens in a new window] ,
Erika Bettermann ,
Michael Kelleman ,
Usama Kanaan ,
Ritu Sachdeva ,
Christopher Petit ,
Dennis Kim ,
Robert Vincent  and
Holly Bauser-Heaton Open the ORCID record for Holly Bauser-Heaton [Opens in a new window]
Soham Dasgupta*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA
Erika Bettermann
Affiliation:
Department of Biostatistics, Emory University, Atlanta, GA, USA
Michael Kelleman
Affiliation:
Department of Biostatistics, Emory University, Atlanta, GA, USA
Usama Kanaan
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA
Ritu Sachdeva
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA
Christopher Petit
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA
Dennis Kim
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA
Robert Vincent
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA
Holly Bauser-Heaton
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA
*
Author for correspondence: Dr S. Dasgupta, MBBS, Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University, 1405 Clifton Road, Atlanta, GA 30322, USA. Tel: +1 404 256 2593. E-mail: dasguptasoham@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Although cardiac catheterisation (cath) is the diagnostic test for pulmonary hypertension, it is an invasive procedure. Echocardiography (echo) is commonly used for the non-invasive diagnosis of pulmonary hypertension but maybe limited by lack of adequate signals. Therefore, emphasis has been placed on biomarkers as a potential diagnostic tool. No prior paediatric studies have simultaneously compared N-terminal pro-B-type-natriuretic peptide (NTproBNP) with cath/echo as a potential diagnostic tool. The aim of this study was to determine if NTproBNP was a reliable diagnostic tool for pulmonary hypertension in this population.

Methods:

Patients were divided into Study (echo evidence/established diagnosis of pulmonary hypertension undergoing cath) and Control (cath for small atrial septal defect/patent ductus arteriosus and endomyocardial biopsy post cardiac transplant) groups. NTproBNP, cath/echo data were obtained.

Results:

Thirty-one patients met inclusion criteria (10 Study, 21 Control). Median NTproBNP was significantly higher in the Study group. Echo parameters including transannular plane systolic excursion z scores, pulmonary artery acceleration time and right ventricular fractional area change were lower in the Study group and correlated negatively with NTproBNP. Receiver operation characteristic curve analysis demonstrated NTproBNP > 389 pg/ml was 87% specific for the diagnosis of pulmonary hypertension with the addition of pulmonary artery acceleration time improving the specificity.

Conclusions:

NTproBNP may be a valuable adjunctive diagnostic tool for pulmonary hypertension in the paediatric population. Echo measures of transannular plane systolic excursion z score, pulmonary artery acceleration time and right ventricular fractional area change had negative correlations with NTproBNP. The utility of NTproBNP as a screening tool for pulmonary hypertension requires validation in a population with unknown pulmonary hypertension status.

Keywords

NTproBNPpulmonary hypertensionpaediatrics
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 10 , October 2021 , pp. 1595 - 1607
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abman, SH, Hansmann, G, Archer, SL, Dunbar Ivy, D, Adatia, I, Chung, WK. Pediatric Pulmonary hypertension- guidelines from the American heart association. Circulation 2015; 132: 2037–2099.CrossRefGoogle Scholar
Rosenzweig, EB, Abman, SH, Adatia, I, et al. Pediatric pulmonary hypertension: updates on definition, classification and management. Eur Respir J 2019; 53: 1801916.CrossRefGoogle ScholarPubMed
Berkelhamer, SK, Mestan, KK, Steinhorn, RH. Pulmonary hypertension in bronchopulmonary dysplasia. Semin Perinatol 2013; 37: 124–131.CrossRefGoogle ScholarPubMed
Chin, KM, Rubin, LJ, Channick, R, et al. Association of N-terminal pro brain natriuretic peptide and long term outcome in patients with pulmonary arterial hypertension. Circulation 2019; 139: 2440–2450.CrossRefGoogle ScholarPubMed
Sandqvist, A, Schneede, J, Kylhammar, D, et al. Plasma L-arginine levels distinguish pulmonary arterial hypertension from left ventricular systolic dysfunction. Heart Vessels 2018; 33: 255–263.CrossRefGoogle ScholarPubMed
Suttner, SW, Boldt, J. Natriuretic peptide system: physiology and clinical utility. Curr Opin Crit Care 2004; 10: 336–341.CrossRefGoogle ScholarPubMed
Montgomery, AM, Bazzy-Asaad, A, Asnes, JD, Bizzarro, MJ, Ehrenkranz, RA, Weismann, CG. Biochemical screening for pulmonary hypertension in preterm infants with bronchopulmonary dysplasia. Neonatology 2016; 109: 190–194.CrossRefGoogle ScholarPubMed
Dasgupta, S, Aly, AM, Malloy, MH, Okorodudu, AO, Jain, SK. NTProBNP as a surrogate biomarker for early screening of pulmonary hypertension in preterm infants with bronchopulmonary dysplasia. J Perinatol 2018; 38: 1252–1257.CrossRefGoogle ScholarPubMed
Koestenberger, M, Ravekes, W, Everett, AD, et al. Right ventricular function in infants, children and adolescents: reference values of the tricuspid annular plane systolic excursion (TAPSE) in 640 healthy patients and calculation of z score values. J Am Soc Echocardiogr 2009; 22: 715–719.CrossRefGoogle ScholarPubMed
Levin, ER, Gardner, DG, Samson, WK. Natriuretic peptides. N Engl J Med 1998; 339: 321–328.Google ScholarPubMed
Alibay, Y, Beauchet, A, El Mahmoud, R, et al. Analytical correlation between plasma N-terminal pro-brain natriuretic peptide and brain natriuretic peptide in patients presenting with dyspnea. Clin Biochem 2004; 37: 933–936.CrossRefGoogle ScholarPubMed
Kemperman, H, van den Berg, M, Kirkels, H, de Jonge, N. B-type natriuretic peptide (BNP) and N-terminal proBNP in patients with end-stage heart failure supported by a left ventricular assist device. Clin Chem 2004; 50: 1670–1672.CrossRefGoogle ScholarPubMed
Fijalkowska, A, Kurzyna, M, Torbicki, A, et al. Serum N-terminal brain natriuretic peptide as a prognostic parameter in patients with pulmonary hypertension. Chest 2006; 129: 1313–1321.CrossRefGoogle ScholarPubMed
Cuna, A, Kandasamy, J, Sims, B. B-type natriuretic peptide and mortality in extremely low birth weight infants with pulmonary hypertension: a retrospective cohort analysis. BMC Pediatr 2014; 14: 68.CrossRefGoogle ScholarPubMed
Rodriguez-Blanco, S, Oulego-Erroz, I, Alonso-Quintela, P, Terroba-Seara, S, Jimenez-Gonzalez, A, Palau-Benavides, M. N-terminal-probrain natriuretic peptide as a biomarker of moderate to severe pulmonary hypertension in perterm infants: a prospective observational study. Pediatr Pulmonol 2018; 53: 1073–1081.CrossRefGoogle Scholar
Amdani, SM, Mian, MUM, Thomas, RL, Ross, RD. NT-pro BNP-A marker for worsening respiratory status and mortality in infants and young children with pulmonary hypertension. Congenit Heart Dis 2018; 13: 499–505.CrossRefGoogle ScholarPubMed
Chida, A, Sato, H, Shintani, M, et al. Soluble ST2 and N-terminal pro-brain natriuretic peptide combination: useful biomarker for predicting outcome of childhood pulmonary arterial hypertension. Circ J 2014; 78: 436–442.CrossRefGoogle Scholar
Ten Kate, CA, Tibboel, D, Kraemer, US. B-type natriuretic peptide as a parameter for pulmonary hypertension in children. A systematic review. Eur J Pediatr 2015; 174: 1267–1275.CrossRefGoogle ScholarPubMed
Rosenzweig, EB, Abman, SH, Adatia, I, et al. Paediatric pulmonary arterial hypertension: updates on definition, classification, diagnosis and management. Eur Resp J 2019; 53: 1801916.CrossRefGoogle Scholar
Koestenberger, M, Friedberg, MK, Nestaas, E, Michel-Behnke, I, Hansmann, G. Thransthoracic echocardiography in the evaluation of pediatric pulmonary hypertension and ventricular dysfunction. Pulm Circ 2016; 6: 15–29.CrossRefGoogle Scholar
Koestenberger, M, Nagel, B, Ravekes, W, et al. Systolic right ventricular function in pediatric and adolescent patients with tetralogy of fallot: echocardiography versus magnetic resonance imaging. J Am Soc Echocardiogr 2011; 24: 45–52.CrossRefGoogle ScholarPubMed
Forfia, P, Fisher, M, Mathai, S, Housten-Harris, T, Hemnes, A, Borlaug, B. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med 2006; 174: 1034–1041.CrossRefGoogle ScholarPubMed
Koestenberger, M, Nagel, B, Avian, A, et al. Systolic right ventricular function in children and young adults with pulmonary artery hypertension secondary to congenital heart disease and tetralogy of fallot: tricuspid annular plane systolic excursion (TAPSE) and magnetic resonance imaging data. Congenital Heart Dis 2012; 7: 250–258.CrossRefGoogle Scholar
Koestenberger, M, Avian, A, Cantinotti, M, Hansmann, G. European pediatric pulmonary vascular disease network. Int J Cardiol 2019; 274: 296–298.CrossRefGoogle Scholar
Di Maria, MV, Younoszai, AK, Mertens, L, et al. RV stroke work in children with pulmonary arrterial hypertension: estimation based on invasive hemodynamic assessment and correlation with outcomes. Heart 2014; 100: 1342–1347.CrossRefGoogle Scholar
Hammerstingl, C, Schueler, R, Bors, L, et al. Diagnostic value of echocardipgraphy in the diagnosis of pulmonary hypertension. PLoS One 2012; 7: e38519.CrossRefGoogle Scholar
Cevik, A, Kula, S, Olgunturk, R, Tunaoglu, FS, Oguz, AD, Saylan, B. Assessment of pulmonary arterial hypertension and vascular resistance by measurements of the pulmonary arterial flow velocity curve in the absence of a measurable tricuspid regurgitant velocity in childhood congenital heart disease. Pediatr Cardiol 2013; 34: 646–655.CrossRefGoogle ScholarPubMed
Ambalavanan, N, Mourani, P. Pulmonary hypertension in bronchopulmonary dysplasia. Birth Defects Res A Clin Mol Teratol 2014; 100: 240–244.CrossRefGoogle ScholarPubMed