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Alkaline Phosphatase: A Biomarker of Cardiac Function in Pediatric Patients

Elizabeth S Makil1,2, Xinyu Tang1,2, Elizabeth A Frazier1,2

  • 1Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Pediatric Cardiology
|February 11, 2017
PubMed

Insights

Alkaline phosphatase (AP) levels are significantly lower in pediatric heart transplant patients with myocardial dysfunction. AP levels increase with therapies aimed at improving heart function, indicating AP

Area of Science:

  • Pediatric Cardiology
  • Biomarker Discovery
  • Cardiac Surgery

Background:

  • Myocardial dysfunction and heart failure are prevalent in pediatric patients with congenital and acquired heart disease.
  • Alkaline phosphatase (AP) has emerged as a potential biomarker for myocardial dysfunction, particularly after the Fontan operation.
  • Pediatric patients with severe myocardial dysfunction requiring orthotopic heart transplant (OHT) may exhibit diminished AP levels.

Purpose of the Study:

  • To investigate the hypothesis that pediatric patients with myocardial dysfunction requiring OHT have lower AP levels compared to normal.
  • To evaluate the association between AP levels and myocardial function in pediatric OHT candidates.
  • To assess the impact of specific therapies on AP levels and cardiac function.

Main Methods:

  • Retrospective review of pediatric patients undergoing OHT between 2007 and 2012.
  • Analysis of demographic data, diagnoses, interventions, and ejection fraction (EF).
  • Calculation of AP Z scores and comparison to normative values using t-tests.

Main Results:

  • A significantly lower mean AP Z score was observed in the study group prior to OHT compared to normal (p < 0.0001).
  • Initiation of ACE inhibitor therapy before OHT correlated with significant increases in both AP and ventricular EF (p < 0.001).
  • Milrinone treatment was associated with an improved EF.

Conclusions:

  • Diminished AP levels are indicative of myocardial dysfunction in pediatric patients awaiting OHT.
  • AP levels increase significantly following the initiation of therapies designed to enhance myocardial function.
  • AP serves as a valuable indicator of myocardial dysfunction in pediatric cardiac patients.

Keywords:
Alkaline phosphataseCongenital heart diseaseHeart failureHeart transplantPediatric

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