Correlation between Heart Failure with N-Terminal-Pro-B Type Natriuretic Peptide and Cardiothoracic Ratio from Chest Radiograph in Pediatric Heart Disease

Abstract

Objective: The aim of this study is to determine the correlation between the symptom of heart failure and basic investigations; N-Terminal-Pro-B Type Natriuretic Peptide (NT-proBNP) and cardiothoracic (CT) ratio from chest radiograph in pediatric heart disease. Methods: One-hundred-eighty children (aged 1-15 years) with underlying heart disease were enrolled in this prospective cross-sectional study. The heart failures were categorized based on the Ross classification into 2 groups, non-heart failure (Ross classification I) and heart failure (Ross classification II-IV). The NT‐proBNP level was determined and chest radiograph was done in posteroanterior upright position for CT ratio. Results: The mean NT-proBNP level was 223.1 pg/ml ( + 180.3) and a mean CT ratio was 53.6% ( + 5.6) in the non-heart failure group. The mean NT-proBNP level was 1,054 pg/ml ( + 1,840.3) and a mean CT ratio was 58.6% ( + 6.1) in heart failure group. There was a significantly positive correlation between heart failure symptoms and the level of NT-proBNP and CT ratio. In this study, the cut-off value of NT-proBNP for heart failure was more than 400 pg/ml (OR 6.97, ROC 0.694, sensitivity 52.6%, specificity 86.3%) and CT ratio more than 55% (OR 3.57, ROC 0.654, sensitivity 68%, specificity 62.8%). Conclusion: In pediatric heart diseases, there are strong positive correlations between heart failure with both NT-proBNP and CT ratio. These correlations help in the diagnosis of heart failure. NT-proBNP level more than 400 pg/ml and CT ratio more than 55% are indicative of heart failure in our population. Both investigations are inexpensive, readily available and do not require specialist experts.