Relationship of NT-proBNP to All-Cause Death and Heart Transplant in Children with Ventricular Dysfunction and Compared to Adults with Heart Failure

Abstract

<h3>Purpose</h3> Plasma NT-proBNP concentration is a widely used diagnostic biomarker for heart failure (HF) in adults and children. We sought to determine whether NT-proBNP concentrations predicted the risk of heart transplantation or death in pediatric HF patients. <h3>Methods</h3> We studied medical records from 109 children with HF in the IBM Watson Explorys database and from 150 children in the Cardiac Biomarkers in Pediatric Cardiomyopathy (PCMR) study. Nonlinear regression with an Emax function was used to model the relationship between NT-proBNP concentrations and the number of events in the two cohorts and with adult patients from Explorys. <h3>Results</h3> All children in the PCMR cohort had dilated cardiomyopathy, whereas the Explorys cohort also included children with congenital heart diseases (Table). Mean age at diagnosis was 3 years in the Explorys cohort and 1.4 years in the PCMR cohort; median NT-proBNP concentrations were 1250 pg/mL and 183.5 pg/mL, respectively. The percentage of deaths and transplantations was higher in the Explorys cohort (7% and 22%, respectively, over 2 years) than in the PCMR cohort (3% and 16%, respectively, over 5 years). Mean estimates of NT-proBNP concentration indicative of half-maximum risk for events (EC50 values) at 2 and 5 years were 3730 pg/mL and 4199 pg/mL, values both close to the mean of 3880 pg/mL established for adults with HF (Figure). <h3>Conclusion</h3> NT-proBNP concentration is suitable for estimating the risk of mortality and morbidity in children with HF, independent of age, and is a candidate surrogate marker for clinical outcome both in adults and children with HF.