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Amino-terminal pro-brain natriuretic peptide in children with latent rheumatic heart disease
Justin P Zachariah1, Twalib Aliku2, Amy Scheel3
1Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
Insights
Amino-terminal pro-brain natriuretic peptide (NT-proBNP) did not differentiate latent rheumatic heart disease (RHD) from controls in children. However, NT-proBNP levels were significantly higher in male RHD cases, suggesting potential sex-specific differences in biomarker utility.
Area of Science:
- Cardiology
- Biomarkers
- Pediatric Health
Background:
- Rheumatic heart disease (RHD) is a significant global cause of premature heart failure.
- Early RHD often presents with valvar regurgitation, leading to ventricular distention and potential elevation of amino-terminal pro-brain natriuretic peptide (NT-proBNP).
Purpose of the Study:
- To evaluate the efficacy of NT-proBNP in distinguishing latent RHD cases identified through echocardiographic screening from healthy controls.
- To explore potential sex-specific differences in NT-proBNP levels in children with latent RHD.
Main Methods:
- The study enrolled 44 Ugandan children, including latent RHD cases and their siblings as controls, matched for age and sex.
- Exclusion criteria included congenital heart disease, pregnancy, left ventricular dilation, ejection fraction below 55%, or other significant health conditions.
- NT-proBNP levels were measured using sandwich immunoassay, with paired t-tests employed for statistical comparison, including sex-specific analyses.
Main Results:
- Overall, mean NT-proBNP concentrations did not significantly differ between RHD cases (105.74 pg/mL) and controls (86.63 pg/mL) (P = 0.3).
- Sex-specific analysis revealed significantly higher NT-proBNP levels in male RHD cases compared to male controls (158.78 pg/mL vs. 76 pg/mL, P = 0.008).
- Female RHD cases showed no significant difference in NT-proBNP levels compared to female controls (75.44 pg/mL vs. 92.30 pg/mL, P = 0.4).
Conclusions:
- Serum NT-proBNP levels were not effective in distinguishing latent RHD from controls in this pediatric cohort.
- Observed sex differences in NT-proBNP may be influenced by sex and within-family environmental exposures.
- Further research is necessary to explore the utility of NT-proBNP and other biomarkers for RHD detection.
Background:
Rheumatic heart disease (RHD) is a global cause of early heart failure. Early RHD is characterized by valvar regurgitation, leading to ventricular distention and possible elaboration of amino-terminal pro-brain natriuretic peptide (NT-proBNP). We investigated the ability of NT-proBNP to distinguish cases of latent RHD detected by echocardiographic screening from the controls.
Materials And Methods:
Ugandan children (N = 44, 36% males, mean age: 12 ± 2 years) with latent RHD (cases) and siblings (controls) by echocardiography were enrolled. Cases and controls were matched for age and sex, and they had normal hemoglobin (mean: 12.8 mg/dL). Children with congenital heart disease, pregnancy, left ventricular dilation or ejection fraction (EF) below 55%, or other acute or known chronic health conditions were excluded. RHD cases were defined by the World Heart Federation (WHF) 2012 consensus guideline criteria as definite. Controls had no echocardiography (echo) evidence for RHD. At the time of echo, venous blood samples were drawn and stored as serum. NT-proBNP levels were measured using sandwich immunoassay. Paired t-tests were used to compare NT-proBNP concentrations including sex-specific analyses.
Results:
The mean NT-proBNP concentration in the cases was 105.74 ± 67.21 pg/mL while in the controls, it was 86.63 ± 55.77 pg/mL. The cases did not differ from the controls (P = 0.3). In sex-specific analyses, male cases differed significantly from the controls (158.78 ± 68.82 versus 76 ± 42.43, P = 0.008). Female cases did not differ from the controls (75.44 ± 45.03 versus 92.30 ± 62.35 respectively, P = 0.4).
Conclusion:
Serum NT-proBNP did not distinguish between latent RHD cases and the controls. Sex and within-family exposures may confound this result. More investigation into biomarker-based RHD detection is warranted.
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