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Association Between Serial B-Type Natriuretic Peptide Levels, Vasoactive Drug Weaning, and Adverse Cardiovascular
Karla L Loss1,2, Jennifer Su1,2, JonDavid Menteer1,2
1Department of Pediatrics, Division of Cardiology Children's Hospital Los Angeles Los Angeles CA USA.
Insights
Serial B-type natriuretic peptide (BNP) level declines in children with acute decompensated heart failure (ADHF) correlate with successful weaning from intravenous vasoactive (IVV) support and fewer adverse cardiovascular (ACV) outcomes. Right ventricular dysfunction independently predicts ACV events.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
- Biomarker Analysis
Background:
- Children with acute decompensated heart failure (ADHF) often require intravenous vasoactive (IVV) support.
- These children face significant risks for adverse cardiovascular (ACV) outcomes.
- The utility of serial B-type natriuretic peptide (BNP) monitoring in this population requires further investigation.
Purpose of the Study:
- To determine if serial changes in B-type natriuretic peptide (BNP) levels are associated with successful weaning from intravenous vasoactive (IVV) support in pediatric acute decompensated heart failure (ADHF).
- To assess the relationship between serial BNP changes and the occurrence of adverse cardiovascular (ACV) outcomes in hospitalized children with ADHF.
Main Methods:
- Retrospective analysis of 131 pediatric hospitalizations for ADHF between 2005 and 2021.
- Evaluation of serial B-type natriuretic peptide (BNP) levels using linear mixed-effects modeling.
- Assessment of weaning from intravenous vasoactive (IVV) support and adverse cardiovascular (ACV) outcomes, with Bonferroni correction for multiple comparisons.
Main Results:
- A more rapid decline in BNP levels was observed in children successfully weaned from IVV support (-0.20 vs. -0.03 2log pg/mL per day, P<0.001).
- Patients without ACV outcomes exhibited a faster BNP decline compared to those with ACV outcomes (-0.17 vs. -0.03 2log pg/mL per day, P<0.001).
- Right ventricular systolic dysfunction was identified as an independent risk factor for ACV outcomes (OR, 2.49; P=0.045).
Conclusions:
- The rate of decline in serial B-type natriuretic peptide (BNP) levels is a significant indicator of successful weaning from intravenous vasoactive (IVV) support in pediatric acute decompensated heart failure (ADHF).
- A slower decline in BNP levels is associated with a higher risk of adverse cardiovascular (ACV) outcomes.
- Right ventricular systolic dysfunction is a key predictor of adverse cardiovascular events in this patient group.
Background:
Children hospitalized with acute decompensated heart failure (ADHF) frequently require intravenous vasoactive (IVV) support drugs and are at risk for adverse cardiovascular (ACV) outcomes. We wished to assess whether serial changes in B-type natriuretic peptide (BNP) levels are associated with successful weaning off IVV support and/or prespecified ACV outcomes in children hospitalized with ADHF.
Methods And Results:
Children hospitalized with ADHF from 2005 to 2021 at our institution were assessed for serial changes in BNP, weaning off of IVV support, and ACV outcomes. Changes in BNP level were evaluated using linear mixed-effects modeling. Bonferroni correction was used to adjust for multiple hypothesis testing. In 131 hospitalizations of children with ADHF, the median age was 4.8 years, with 74% receiving IVV support. ACV outcomes occurred in 62 children. IVV support was associated with lower admission left ventricular ejection fraction (26.7% versus 32%, P=0.002), more severe left ventricular dilation (left ventricular internal diastolic dimension Z score 5.9 versus 3.1, P=0.021) moderate or more mitral regurgitation (41.3% versus 20.6%, P=0.038), and qualitative right ventricular systolic dysfunction (in 45.4% versus 11.8%, P<0.001). Decline in BNP levels was more rapid in patients who were successfully weaned from IVV support (-0.20 versus -0.03 2log pg/mL per day, P<0.001) and in the non-ACV group (-0.17 versus -0.03 2log pg/mL per day, P<0.001). Right ventricular systolic dysfunction was an independent risk factor for ACV (odds ratio, 2.49; P=0.045).
Conclusions:
The declining rate of serial BNP levels was associated with weaning from IVV support and no ACV outcomes in children hospitalized with ADHF. Right ventricular systolic dysfunction was associated with ACV outcomes.
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