Plasma N-terminal Pro Brain Natriuretic Peptide as a Prognostic Biomarker in Children with Pulmonary Hypertension

Aim: To evaluate plasma level of N-terminal pro brain natriuretic peptide (NT pro-BNP) as a prognostic biomarker in children with pulmonary hypertension (PH) due to congenital heart disease (CHD).

Study Design: Prospective case controlled study.

Place and Duration of the Study: Pediatric cardiology department, Tanta University hospital, Egypt during the period from February 2016 to February 2017.

Methodology: Thirty children with PH due to CHD were enrolled as patients group. Thirty healthy children of matched age and sex were taken as control group. All children were evaluated by echocardiography and plasma level of NT pro-BNP at admission. We followed up patients for 6 months after discharge for adverse effects, mortality or readmission.

Results: Plasma level of NT pro-BNP was significantly elevated in patient group than control group (P=0.001). Both systolic and diastolic functions of left ventricle and right ventricle were impaired in patient group compared to control group. Moreover, both left ventricular and right ventricular dimensions were increased in patient group than control group. Plasma NT pro-BNP was significantly elevated in patient with unfavorable prognosis compared to patients with favorable prognosis (P<0.001). Plasma NT pro-BNP level was positively correlated with heart rate, estimated systolic pulmonary artery pressure and left ventricular end systolic dimension. While, it was significantly inversely correlated with left ventricular fraction shortening, left ventricular E’/A’ ratio, right ventricular outlet fraction shortening and right ventricular E’/A’ ratio. Receiving operating characteristics curve showed that sensitivity of NT pro BNP as a prognostic biomarker in PH patients was 100% and specificity was 92% at cutoff value of more than 103 pg/ml.

Conclusion: NT pro-BNP may serve as a reliable biomarker for predicting adverse outcome in children with PH due to CHD.