Factors associated with serum B-type natriuretic peptide in infants with single ventricles

Ryan J. Butts, Victor Zak, Daphne Hsu, James Cnota, Steven D. Colan, David Hehir, Paul Kantor, Jami C. Levine, Renee Margossian, Marc Richmond, Anita Szwast, Derek Williams, Richard Williams, Andrew M. Atz

Research output: Contribution to journalArticle

6 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)879-887
Number of pages9
JournalPediatric Cardiology
Volume35
Issue number5
DOIs
StatePublished - Jan 1 2014

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Brain Natriuretic Peptide
Serum
Norwood Procedures
Enzyme Therapy
Systole
Peptidyl-Dipeptidase A
Growth
Catheterization
Multicenter Studies
Echocardiography
Cardiac Arrhythmias
Dilatation
Length of Stay

Keywords

  • Angiotensin-converting enzyme inhibition therapy
  • B-type natriuretic peptide
  • BNP
  • SCPC
  • Single-ventricle physiology
  • Superior cavopulmonary connection surgery
  • Ventricular dilation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

Cite this

Factors associated with serum B-type natriuretic peptide in infants with single ventricles. / Butts, Ryan J.; Zak, Victor; Hsu, Daphne; Cnota, James; Colan, Steven D.; Hehir, David; Kantor, Paul; Levine, Jami C.; Margossian, Renee; Richmond, Marc; Szwast, Anita; Williams, Derek; Williams, Richard; Atz, Andrew M.

In: Pediatric Cardiology, Vol. 35, No. 5, 01.01.2014, p. 879-887.

Research output: Contribution to journalArticle

Butts, RJ, Zak, V, Hsu, D, Cnota, J, Colan, SD, Hehir, D, Kantor, P, Levine, JC, Margossian, R, Richmond, M, Szwast, A, Williams, D, Williams, R & Atz, AM 2014, 'Factors associated with serum B-type natriuretic peptide in infants with single ventricles', Pediatric Cardiology, vol. 35, no. 5, pp. 879-887. https://doi.org/10.1007/s00246-014-0872-z
Butts, Ryan J. ; Zak, Victor ; Hsu, Daphne ; Cnota, James ; Colan, Steven D. ; Hehir, David ; Kantor, Paul ; Levine, Jami C. ; Margossian, Renee ; Richmond, Marc ; Szwast, Anita ; Williams, Derek ; Williams, Richard ; Atz, Andrew M. / Factors associated with serum B-type natriuretic peptide in infants with single ventricles. In: Pediatric Cardiology. 2014 ; Vol. 35, No. 5. pp. 879-887.
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T1 - Factors associated with serum B-type natriuretic peptide in infants with single ventricles

AU - Butts, Ryan J.

AU - Zak, Victor

AU - Hsu, Daphne

AU - Cnota, James

AU - Colan, Steven D.

AU - Hehir, David

AU - Kantor, Paul

AU - Levine, Jami C.

AU - Margossian, Renee

AU - Richmond, Marc

AU - Szwast, Anita

AU - Williams, Derek

AU - Williams, Richard

AU - Atz, Andrew M.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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.

AB - 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.

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KW - B-type natriuretic peptide

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KW - Single-ventricle physiology

KW - Superior cavopulmonary connection surgery

KW - Ventricular dilation

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