Abstract
Although B-type Natriuretic Peptide (BNP), N-terminal-proBNP (NT-proBNP), and mid-regional-proANP (MR-proANP) are included in current guidelines on heart failure in adults, no guideline considering these biomarkers in pediatric heart failure is available. A new drug class of neprilysin inhibitors as fixed-dose combination (Sacubitril/valsartan) has been introduced and is currently being investigated in children suffering from heart failure. Atrial Natriuretic Peptide (ANP) is discussed as a more useful alternative to BNP because it may grants better insights into the effects of this treatment. Thus, this review aimed to provide an overview of the current knowledge concerning ANP in pediatric heart failure and compares its suitability regarding diagnosis and prognosis of heart failure. A literature search using PubMed resulted in 147 publications of which 22 studies were classified as relevant. The review presents available ANP, NT-proANP, and MR-proANP level data in children (0–18 years). Summarizing, ANP shows only minor differences as marker for diagnosing and monitoring pediatric heart failure if compared to BNP. Due to its fast release, ANP offers the advantage of displaying rapid changes during therapy or operation. ANP is -like the other natriuretic peptides- influenced by age, presenting with the highest levels in very young infants. ANP also correlates with atrial pressure and volume overload in children. In addition, ANP determination in saliva appears to be a promising alternative to blood sampling. Similarly to NT-proBNP, NT-proANP, and MR-proANP offer better stability but only few data has been published in children and thus their potential is only presumable so far.
Highlights
Heart failure has been defined as a clinical and pathophysiologic syndrome that results from ventricular dysfunction, volume or pressure overload or a combination of these causes
This review provides an overview outlining the current knowledge on pediatric Atrial Natriuretic Peptide (ANP) levels focusing on its usefulness in diagnosis, monitoring and different etiology of heart failure
ANP serves as a helpful marker for the diagnosis of pediatric heart failure and follow-up of treatment and after operation in children
Summary
Heart failure has been defined as a clinical and pathophysiologic syndrome that results from ventricular dysfunction, volume or pressure overload or a combination of these causes. Identifying Children With Heart Failure Concerning the diagnosis of heart failure, ANP levels are significantly increased in diseased children compared to healthy controls (15, 26, 31). Regarding asymptomatic pediatric CHD, ANP is to BNP not necessarily significantly elevated compared to healthy. When comparing elevated ANP levels resulting from different etiologies of heart failure, the highest were observed in systolic ventricular dysfunction (median: 431 pg/mL) followed by volume overload with preserved systolic dysfunction (median: 93.0 pg/mL). Kotby et al confirmed that in left ventricular volume overload resulting from different etiologies, levels of ANP are significantly elevated compared to controls (17). Pediatric patients with DCM present with the highest levels of ANP and MR-proANP—fully in line with the BNP data (Table 1.3d) (9, 15, 17, 34, 43). DIFFERENTIATION OF SYMPTOMATIC (S) AND ASYMPTOMATIC (A) CONGENITAL HEART DISEASE
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