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CLINICAL RESEARCH: BIOMARKERS

Accuracy of Plasma B-Type Natriuretic Peptide to Diagnose Significant Cardiovascular Disease in Children

The Better Not Pout Children! Study

Yuk M. Law, MD^_*,_*, Andrew W. Hoyer, MD, Mark D. Reller, MD and Michael Silberbach, MD

^_* Pediatric Cardiology, Department of Pediatrics, Children's Hospital and Regional Medical Center, University of Washington, Seattle, Washington
University of Virginia, Charlottesville, Virginia
Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon

Manuscript received December 16, 2008; revised manuscript received May 13, 2009, accepted June 2, 2009.

^_* Reprint requests and correspondence: Dr. Yuk M. Law, Children's Hospital and Regional Medical Center, University of Washington, 4800 Sand Point Way NE, M/S G-0035, Seattle, Washington 98105 (Email: yuk.law{at}seattlechildrens.org).

Objectives: The purpose of this study was to assess the ability of plasma B-type natriuretic peptide (BNP) to diagnose significant cardiovascular disease (CVD) in the pediatric population.

Background: BNP has been shown to be reliable in detecting ventricular dysfunction and heart failure in adults. Timely and accurate identification of significant pediatric heart disease is important but challenging. A simple blood test could aid the front-line physician in this task.

Methods: Subjects without a history of heart disease with findings possibly attributable to significant CVD in the acute care setting requiring a cardiology consult were enrolled. Clinicians were blinded to the BNP result, and confirmation of disease was made by cardiology consultation.

Results: Subjects were divided into a neonatal (n = 42, 0 to 7 days) and older age group (n = 58, >7 days to 19 years). CVD was present in 74% of neonates and 53% of the older age group. In neonates with disease, median BNP was 526 pg/ml versus 96 pg/ml (p < 0.001) for those without disease. In older children with disease, median BNP was 122 pg/ml versus 22 pg/ml in those without disease (p < 0.001). Subjects with disease from an anatomic defect, a longer hospital stay, or who died had higher BNP. A BNP of 170 pg/ml yielded a sensitivity of 94% and specificity of 73% in the neonatal group and 87% and 70% in the older age group, respectively, using a BNP of 41 pg/ml.

Conclusions: BNP is a reliable test to diagnose significant structural or functional CVD in children. Optimal cutoff values are different from adult values.

Key Words: B-type natriuretic peptide • cardiovascular disease • children • biomarkers • heart failure

Abbreviations and Acronyms   BNP = B-type natriuretic peptide   CVD = cardiovascular disease   CXR = chest X-ray   NPV = negative predictive value   PPV = positive predictive value

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