Iranian Heart Journal

Iranian Heart Journal

N-terminal pro B-type Natriuretic Peptide Levels and Dilated Cardiomyopathy: A Tissue Doppler Echocardiographic Study in Children

Document Type : Original Article

Authors
Avisa Tabib 1
Mohammad Mahdavi 2
Maryam Moradian 2
Feisal Rahimpour 3
Yousef Rezaei 1
1 Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
2 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
3 Pediatric Department, Medical Faculty, Mashhad University of Medical Sciences (MUMS), Mashhad, IR Iran.
Abstract
Background: The N-terminal segment of the pro-brain natriuretic peptide (NT-proBNP) has emerged as a marker for heart failure. Dilated cardiomyopathy (DCM) as a major cause of congestive heart failure in children leads to a low cardiac output. However, only a few studies have shown the role of tissue Doppler imaging (TDI) in children with DCM. We sought to explore the associations between TDI parameters and NT-proBNP among DCM patients.
 
Methods: The present cross-sectional study consecutively enrolled 28 children with DCM. All the patients were on medical therapies in a stable condition upon entrance into the study. All the children were examined by 2D transthoracic echocardiography. TDI imaging was taken from lateral and septal mitral valve areas, and myocardial velocity was calculated by TDI. All the children gave blood samples for the measurement of the NT-proBNP level.
 
Results: Seventeen patients (60.7%) were female, and the patients’ median age was 10 (IQR25%-75%: 1 to 13) years. The NT-proBNP median was 8614 (IQR25%-75%, 2592 to 20909) pg/mL. There were statistically significant linear relationships between the NT-proBNP level and the lateral myocardial performance index (MPI) (ρ=0.416), the septal MPI (ρ=0.740), the septal E/e´ (ρ=0.533), and the lateral E/e´ (ρ=0.448). The strongest correlation coefficients were observed between the NT-proBNP level and the left ventricular ejection fraction (ρ= −0.754; P=0.001) and the septal MPI (ρ=0.740; P=0.001), even after indexing by body surface area.
 
Conclusions: NT-proBNP levels correlated strongly with the left ventricular function measured by TDI parameters. Noninvasive echocardiographic evaluations can be implemented to assess children with DCM. (Iranian Heart Journal 2022; 23(1): 54-64)
Keywords
Dilated cardiomyopathy
Brain natriuretic peptides
Tissue Doppler imaging
Echocardiography
  1. Cowie MR, Mendez GF. BNP and congestive heart failure. Prog Cardiovasc Dis 2002; 44:293-321.
  2. Tabib A, Emamzadegan R, Bakhshandeh H, Givtaj N. Prognostic Value of Serum B-Type Natriuretic Peptide in Early Mortality and Morbidity of Children with Congenital Heart Disease after Open Heart Surgery. Journal of Tehran University Heart Center 2009; 4.
  3. Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Clopton P, Steg PG, Westheim A, Knudsen CW, Perez A, Kazanegra R, Herrmann HC, McCullough PA. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002; 347:161-167.
  4. Yeo KT, Wu AH, Apple FS, Kroll MH, Christenson RH, Lewandrowski KB, Sedor FA, Butch AW. Multicenter evaluation of the Roche NT-proBNP assay and comparison to the Biosite Triage BNP assay. Clin Chim Acta 2003; 338:107-115.
  5. Das BB. Plasma B-type natriuretic peptides in children with cardiovascular diseases. Pediatric cardiology 2010; 31:1135-1145.
  6. Koulouri S, Acherman RJ, Wong PC, Chan LS, Lewis AB. Utility of B-type natriuretic peptide in differentiating congestive heart failure from lung disease in pediatric patients with respiratory distress. Pediatric cardiology 2004; 25:341-346.
  7. den Boer SL, Rizopoulos D, du Marchie Sarvaas GJ, Backx AP, Ten Harkel AD, van Iperen GG, Rammeloo LA, Tanke RB, Boersma E, Helbing WA, Dalinghaus M. Usefulness of Serial N-terminal Pro-B-type Natriuretic Peptide Measurements to Predict Cardiac Death in Acute and Chronic Dilated Cardiomyopathy in Children. The American journal of cardiology 2016; 118:1723-1729.
  8. Sacca L. Heart failure as a multiple hormonal deficiency syndrome. Circ Heart Fail 2009; 2:151-156.
  9. Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, Moss AJ, Seidman CE, Young JB. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation 2006; 113:1807-1816.
  10. Tsirka AE, Trinkaus K, Chen SC, Lipshultz SE, Towbin JA, Colan SD, Exil V, Strauss AW, Canter CE. Improved outcomes of pediatric dilated cardiomyopathy with utilization of heart transplantation. Journal of the American College of Cardiology 2004; 44:391-397.
  11. Mir TS, Marohn S, Laer S, Eiselt M, Grollmus O, Weil J. Plasma concentrations of N-terminal pro-brain natriuretic peptide in control children from the neonatal to adolescent period and in children with congestive heart failure. Pediatrics 2002; 110:e76.
  12. Auerbach SR, Richmond ME, Lamour JM, Blume ED, Addonizio LJ, Shaddy RE, Mahony L, Pahl E, Hsu DT. BNP levels predict outcome in pediatric heart failure patients: post hoc analysis of the Pediatric Carvedilol Trial. Circ Heart Fail 2010; 3:606-611.
  13. Price JF, Thomas AK, Grenier M, Eidem BW, O'Brian Smith E, Denfield SW, Towbin JA, Dreyer WJ. B-type natriuretic peptide predicts adverse cardiovascular events in pediatric outpatients with chronic left ventricular systolic dysfunction. Circulation 2006; 114:1063-1069.
  14. Kim G, Lee OJ, Kang IS, Song J, Huh J. Clinical implications of serial serum N-terminal prohormone brain natriuretic peptide levels in the prediction of outcome in children with dilated cardiomyopathy. The American journal of cardiology 2013; 112:1455-1460.
  15. Naderi N, Heidarali M, Barzegari F, Ghadrdoost B, Amin A, Taghavi S. Hormonal Profile in Patients With Dilated Cardiomyopathy. Res Cardiovasc Med 2015; 4:e27631.
  16. Iacob D, Butnariu A, Leucuta DC, Samasca G, Deleanu D, Lupan I. Evaluation of NT-proBNP in children with heart failure younger than 3 years old. Rom J Intern Med 2017; 55:69-74.
  17. Sohn DW, Chai IH, Lee DJ, Kim HC, Kim HS, Oh BH, Lee MM, Park YB, Choi YS, Seo JD, Lee YW. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 1997; 30:474-480.
  18. Alam M, Wardell J, Andersson E, Samad BA, Nordlander R. Effects of first myocardial infarction on left ventricular systolic and diastolic function with the use of mitral annular velocity determined by pulsed wave doppler tissue imaging. J Am Soc Echocardiogr 2000; 13:343-352.
  19. Al-Biltagi MA, Abd Rab Elrasoul Tolba O, El Mahdy H, Donia A, Elbanna S. Echocardiographic assessment of left ventricular dyssynchrony in Egyptian children with congestive heart failure due to dilated cardiomyopathy. Cardiol Young 2015; 25:1173-1181.
  20. Mohammed A, Mertens L, Friedberg MK. Relations between systolic and diastolic function in children with dilated and hypertrophic cardiomyopathy as assessed by tissue Doppler imaging. J Am Soc Echocardiogr 2009; 22:145-151.
  21. Pinto YM, Elliott PM, Arbustini E, Adler Y, Anastasakis A, Bohm M, Duboc D, Gimeno J, de Groote P, Imazio M, Heymans S, Klingel K, Komajda M, Limongelli G, Linhart A, Mogensen J, Moon J, Pieper PG, Seferovic PM, Schueler S, Zamorano JL, Caforio AL, Charron P. Proposal for a revised definition of dilated cardiomyopathy, hypokinetic non-dilated cardiomyopathy, and its implications for clinical practice: a position statement of the ESC working group on myocardial and pericardial diseases. Eur Heart J 2016; 37:1850-1858.
  22. Tekten T, Onbasili AO, Ceyhan C, Unal S, Discigil B. Value of measuring myocardial performance index by tissue Doppler echocardiography in normal and diseased heart. Japanese heart journal 2003; 44:403-416.
  23. Cantinotti M, Giordano R, Scalese M, Murzi B, Assanta N, Spadoni I, Crocetti M, Marotta M, Molinaro S, Kutty S, Iervasi G. Nomograms for mitral inflow Doppler and tissue Doppler velocities in Caucasian children. Journal of cardiology 2016; 68:288-299.
  24. Nir A, Lindinger A, Rauh M, Bar-Oz B, Laer S, Schwachtgen L, Koch A, Falkenberg J, Mir TS. NT-pro-B-type natriuretic peptide in infants and children: reference values based on combined data from four studies. Pediatric cardiology 2009; 30:3-8.
  25. Koura HM, Abdalla NM, Hamed Ibrahim M, Abo Hashish MM, Zaki SM. NT-proBNP in Children With Left to Right Shunt and Dilated Cardiomyopathy. Iran J Pediatr 2016; 26:e4485.
  26. Kocharian A, Shabanian R, Rahimzadeh M, Kiani A, Hosseini A, Zanjani KS, Heidari-Bateni G, Hosseini-Navid N. N-terminal pro-B-type natriuretic peptide and ventricular dysfunction in children and adolescents. Cardiol Young 2009; 19:580-588.
  27. Foster E, Lease KE. New untwist on diastole: what goes around comes back. Circulation 2006; 113:2477-2479.
  28. Goto T, Ohte N, Wakami K, Asada K, Fukuta H, Mukai S, Tani T, Kimura G. Usefulness of plasma brain natriuretic peptide measurement and tissue Doppler imaging in identifying isolated left ventricular diastolic dysfunction without heart failure. The American journal of cardiology 2010; 106:87-91.
  29. Mak GS, DeMaria A, Clopton P, Maisel AS. Utility of B-natriuretic peptide in the evaluation of left ventricular diastolic function: comparison with tissue Doppler imaging recordings. Am Heart J 2004; 148:895-902.
  30. Maisel AS, Koon J, Krishnaswamy P, Kazenegra R, Clopton P, Gardetto N, Morrisey R, Garcia A, Chiu A, De Maria A. Utility of B-natriuretic peptide as a rapid, point-of-care test for screening patients undergoing echocardiography to determine left ventricular dysfunction. Am Heart J 2001; 141:367-374.
  31. Park HS, Naik SD, Aronow WS, Visintainer PF, Das M, McClung JA, Belkin RN. Differences of lateral and septal mitral annulus velocity by tissue Doppler imaging in the evaluation of left ventricular diastolic function. The American journal of cardiology 2006; 98:970-972.
  32. Baggish AL, van Kimmenade RR, Januzzi JL, Jr. Amino-terminal pro-B-type natriuretic peptide testing and prognosis in patients with acute dyspnea, including those with acute heart failure. The American journal of cardiology 2008; 101:49-55.
  33. Kantor PF, Rusconi P, Lipshultz S, Mital S, Wilkinson JD, Burch M. Current applications and Future Needs for Biomarkers in Pediatric Cardiomyopathy and Heart Failure: Summary From The Second International Conference On Pediatric Cardiomyopathy. Progress in pediatric cardiology 2011; 32:11-14.
Iranian Heart Journal
Volume 23, Issue 1
Winter 2022
Pages 54-64