BNP levels predict outcome in pediatric heart failure patients post hoc analysis of the Pediatric Carvedilol Trial

Scott R. Auerbach, Marc E. Richmond, Jacqueline M. Lamour, Elizabeth D. Blume, Linda J. Addonizio, Robert E. Shaddy, Lynn Mahony, Elfriede Pahl, Daphne T. Hsu

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

Background-The ability of serum B-type natriuretic peptide levels (BNP) to predict outcomes in children with heart failure (HF) has not been well demonstrated. This study was designed to determine whether BNP levels predict outcomes in patients with moderate symptomatic HF. Methods and Results-We investigated whether enrollment BNP levels for the Pediatric Carvedilol Trial were associated with baseline characteristics. Freedom from a composite end point of HF hospitalization, death, or transplantation at 9 months was compared using a threshold BNP level identified using receiver operating curve analysis. Median BNP level was 110 pg/mL (interquartile range, 22.4 to 342.0 pg/mL) in 138 subjects. Median age was 3.4 years (interquartile range, 1.1 to 11.0 years). Diagnoses were cardiomyopathy (60%) and congenital heart disease (40%); 73% had a systemic left ventricle. BNP levels correlated moderately with left ventricular ejection fraction (R=039, P<0.001) but did not differ by HF class, age, diagnosis, sex, ventricular morphology, or left ventricular end-diastolic dimension Z-score (R=0.19). Outcome events included 25 HF hospitalizations, 4 deaths, and 2 transplants. Sensitivity was 71% and specificity 63%, for a BNP cutoff value of 140 pg/mL. BNP ≥140 pg/mL (hazard ratio, 3.7; 95% confidence interval, 1.62 to 8.4; P=0.002) and age >2 years (hazard ratio, 4.45; 95% confidence interval, 1.68 to 12.04; P=0.003) were independently associated with worse outcomes. Conclusions-In children with moderately symptomatic HF, BNP ≥140 pg/mL and age >2 years identified subjects at higher risk for worse outcome. Further validation is needed to determine the BNP levels necessary to stratify risk in other pediatric cohorts.

Original languageEnglish (US)
Pages (from-to)606-611
Number of pages6
JournalCirculation: Heart Failure
Volume3
Issue number5
DOIs
StatePublished - Sep 2010

Fingerprint

Brain Natriuretic Peptide
Heart Failure
Pediatrics
carvedilol
Cardiomyopathies
Stroke Volume
Heart Ventricles
Heart Diseases
Hospitalization
Transplantation
Confidence Intervals
Serum

Keywords

  • Cardiomyopathy
  • Heart failure
  • Natriuretic peptides
  • Pediatrics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Auerbach, S. R., Richmond, M. E., Lamour, J. M., Blume, E. D., Addonizio, L. J., Shaddy, R. E., ... Hsu, D. T. (2010). BNP levels predict outcome in pediatric heart failure patients post hoc analysis of the Pediatric Carvedilol Trial. Circulation: Heart Failure, 3(5), 606-611. https://doi.org/10.1161/CIRCHEARTFAILURE.109.906875

BNP levels predict outcome in pediatric heart failure patients post hoc analysis of the Pediatric Carvedilol Trial. / Auerbach, Scott R.; Richmond, Marc E.; Lamour, Jacqueline M.; Blume, Elizabeth D.; Addonizio, Linda J.; Shaddy, Robert E.; Mahony, Lynn; Pahl, Elfriede; Hsu, Daphne T.

In: Circulation: Heart Failure, Vol. 3, No. 5, 09.2010, p. 606-611.

Research output: Contribution to journalArticle

Auerbach, SR, Richmond, ME, Lamour, JM, Blume, ED, Addonizio, LJ, Shaddy, RE, Mahony, L, Pahl, E & Hsu, DT 2010, 'BNP levels predict outcome in pediatric heart failure patients post hoc analysis of the Pediatric Carvedilol Trial', Circulation: Heart Failure, vol. 3, no. 5, pp. 606-611. https://doi.org/10.1161/CIRCHEARTFAILURE.109.906875
Auerbach, Scott R. ; Richmond, Marc E. ; Lamour, Jacqueline M. ; Blume, Elizabeth D. ; Addonizio, Linda J. ; Shaddy, Robert E. ; Mahony, Lynn ; Pahl, Elfriede ; Hsu, Daphne T. / BNP levels predict outcome in pediatric heart failure patients post hoc analysis of the Pediatric Carvedilol Trial. In: Circulation: Heart Failure. 2010 ; Vol. 3, No. 5. pp. 606-611.
@article{3fbbedbc47a14a36a1ecffc15221cbd9,
title = "BNP levels predict outcome in pediatric heart failure patients post hoc analysis of the Pediatric Carvedilol Trial",
abstract = "Background-The ability of serum B-type natriuretic peptide levels (BNP) to predict outcomes in children with heart failure (HF) has not been well demonstrated. This study was designed to determine whether BNP levels predict outcomes in patients with moderate symptomatic HF. Methods and Results-We investigated whether enrollment BNP levels for the Pediatric Carvedilol Trial were associated with baseline characteristics. Freedom from a composite end point of HF hospitalization, death, or transplantation at 9 months was compared using a threshold BNP level identified using receiver operating curve analysis. Median BNP level was 110 pg/mL (interquartile range, 22.4 to 342.0 pg/mL) in 138 subjects. Median age was 3.4 years (interquartile range, 1.1 to 11.0 years). Diagnoses were cardiomyopathy (60{\%}) and congenital heart disease (40{\%}); 73{\%} had a systemic left ventricle. BNP levels correlated moderately with left ventricular ejection fraction (R=039, P<0.001) but did not differ by HF class, age, diagnosis, sex, ventricular morphology, or left ventricular end-diastolic dimension Z-score (R=0.19). Outcome events included 25 HF hospitalizations, 4 deaths, and 2 transplants. Sensitivity was 71{\%} and specificity 63{\%}, for a BNP cutoff value of 140 pg/mL. BNP ≥140 pg/mL (hazard ratio, 3.7; 95{\%} confidence interval, 1.62 to 8.4; P=0.002) and age >2 years (hazard ratio, 4.45; 95{\%} confidence interval, 1.68 to 12.04; P=0.003) were independently associated with worse outcomes. Conclusions-In children with moderately symptomatic HF, BNP ≥140 pg/mL and age >2 years identified subjects at higher risk for worse outcome. Further validation is needed to determine the BNP levels necessary to stratify risk in other pediatric cohorts.",
keywords = "Cardiomyopathy, Heart failure, Natriuretic peptides, Pediatrics",
author = "Auerbach, {Scott R.} and Richmond, {Marc E.} and Lamour, {Jacqueline M.} and Blume, {Elizabeth D.} and Addonizio, {Linda J.} and Shaddy, {Robert E.} and Lynn Mahony and Elfriede Pahl and Hsu, {Daphne T.}",
year = "2010",
month = "9",
doi = "10.1161/CIRCHEARTFAILURE.109.906875",
language = "English (US)",
volume = "3",
pages = "606--611",
journal = "Circulation. Heart failure",
issn = "1941-3297",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - BNP levels predict outcome in pediatric heart failure patients post hoc analysis of the Pediatric Carvedilol Trial

AU - Auerbach, Scott R.

AU - Richmond, Marc E.

AU - Lamour, Jacqueline M.

AU - Blume, Elizabeth D.

AU - Addonizio, Linda J.

AU - Shaddy, Robert E.

AU - Mahony, Lynn

AU - Pahl, Elfriede

AU - Hsu, Daphne T.

PY - 2010/9

Y1 - 2010/9

N2 - Background-The ability of serum B-type natriuretic peptide levels (BNP) to predict outcomes in children with heart failure (HF) has not been well demonstrated. This study was designed to determine whether BNP levels predict outcomes in patients with moderate symptomatic HF. Methods and Results-We investigated whether enrollment BNP levels for the Pediatric Carvedilol Trial were associated with baseline characteristics. Freedom from a composite end point of HF hospitalization, death, or transplantation at 9 months was compared using a threshold BNP level identified using receiver operating curve analysis. Median BNP level was 110 pg/mL (interquartile range, 22.4 to 342.0 pg/mL) in 138 subjects. Median age was 3.4 years (interquartile range, 1.1 to 11.0 years). Diagnoses were cardiomyopathy (60%) and congenital heart disease (40%); 73% had a systemic left ventricle. BNP levels correlated moderately with left ventricular ejection fraction (R=039, P<0.001) but did not differ by HF class, age, diagnosis, sex, ventricular morphology, or left ventricular end-diastolic dimension Z-score (R=0.19). Outcome events included 25 HF hospitalizations, 4 deaths, and 2 transplants. Sensitivity was 71% and specificity 63%, for a BNP cutoff value of 140 pg/mL. BNP ≥140 pg/mL (hazard ratio, 3.7; 95% confidence interval, 1.62 to 8.4; P=0.002) and age >2 years (hazard ratio, 4.45; 95% confidence interval, 1.68 to 12.04; P=0.003) were independently associated with worse outcomes. Conclusions-In children with moderately symptomatic HF, BNP ≥140 pg/mL and age >2 years identified subjects at higher risk for worse outcome. Further validation is needed to determine the BNP levels necessary to stratify risk in other pediatric cohorts.

AB - Background-The ability of serum B-type natriuretic peptide levels (BNP) to predict outcomes in children with heart failure (HF) has not been well demonstrated. This study was designed to determine whether BNP levels predict outcomes in patients with moderate symptomatic HF. Methods and Results-We investigated whether enrollment BNP levels for the Pediatric Carvedilol Trial were associated with baseline characteristics. Freedom from a composite end point of HF hospitalization, death, or transplantation at 9 months was compared using a threshold BNP level identified using receiver operating curve analysis. Median BNP level was 110 pg/mL (interquartile range, 22.4 to 342.0 pg/mL) in 138 subjects. Median age was 3.4 years (interquartile range, 1.1 to 11.0 years). Diagnoses were cardiomyopathy (60%) and congenital heart disease (40%); 73% had a systemic left ventricle. BNP levels correlated moderately with left ventricular ejection fraction (R=039, P<0.001) but did not differ by HF class, age, diagnosis, sex, ventricular morphology, or left ventricular end-diastolic dimension Z-score (R=0.19). Outcome events included 25 HF hospitalizations, 4 deaths, and 2 transplants. Sensitivity was 71% and specificity 63%, for a BNP cutoff value of 140 pg/mL. BNP ≥140 pg/mL (hazard ratio, 3.7; 95% confidence interval, 1.62 to 8.4; P=0.002) and age >2 years (hazard ratio, 4.45; 95% confidence interval, 1.68 to 12.04; P=0.003) were independently associated with worse outcomes. Conclusions-In children with moderately symptomatic HF, BNP ≥140 pg/mL and age >2 years identified subjects at higher risk for worse outcome. Further validation is needed to determine the BNP levels necessary to stratify risk in other pediatric cohorts.

KW - Cardiomyopathy

KW - Heart failure

KW - Natriuretic peptides

KW - Pediatrics

UR - http://www.scopus.com/inward/record.url?scp=77957922082&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77957922082&partnerID=8YFLogxK

U2 - 10.1161/CIRCHEARTFAILURE.109.906875

DO - 10.1161/CIRCHEARTFAILURE.109.906875

M3 - Article

C2 - 20573993

AN - SCOPUS:77957922082

VL - 3

SP - 606

EP - 611

JO - Circulation. Heart failure

JF - Circulation. Heart failure

SN - 1941-3297

IS - 5

ER -