Congestive Heart Failure In Children Research Articles

Serum-soluble suppression of tumourigenicity-2 as a biomarker in children with congestive heart failure.

We aimed to evaluate serum soluble suppression of tumorigenicity-2 in children with congestive heart failure, to assess the diagnostic and prognostic values of soluble suppression of tumorigenicity-2 in these patients, and to correlate its levels with various clinical and echocardiographic data. We included 60 children with congestive heart failure as the patient group. Sixty healthy children of matched age and sex served as the control group. Patients were evaluated clinically and by echocardiography. Serum level of suppression of tumorigenicity-2 was measured for patients at admission. All patients were followed up for death or readmission for a period of one year. Soluble suppression of tumorigenicity-2 was significantly higher in children with congestive heart failure as compared to the control group. Soluble suppression of tumorigenicity-2 was significantly increased in patients with higher severity of congestive heart failure. There was a significant increase in soluble suppression of tumorigenicity-2 in patients with bad prognosis compared to those with good prognosis. There was a significant positive correlation between soluble suppression of tumorigenicity-2 and respiratory rate, heart rate, and clinical stage of congenital heart failure, while there was a significant negative correlation between soluble suppression of tumorigenicity-2 and left ventricular systolic and diastolic function. The best cut-off of soluble suppression of tumorigenicity-2 to diagnose congestive heart failure was > 3.6 with 87% sensitivity and 79% specificity. The cut-off point of soluble suppression of tumorigenicity-2 to diagnose congestive heart failure in children was ≥ 31.56 ng/ml, with 95% sensitivity and 91.37% specificity. Moreover, the cut-off point of soluble suppression of tumorigenicity-2 to predict bad prognosis in children with congestive heart failure was ≥ 255.5 ng/ml, with 92% sensitivity and 89.0% specificity. Soluble suppression of tumorigenicity-2 is a good diagnostic and predictive biomarker in children with congestive heart failure.

Etiology of Congestive Heart Failure in Children

Objective: To determine the frequency of common causes of congestive heart failure among children in a tertiary care hospital. Study Design: Cross-sectional study Place and Duration of Study: Department of Paediatrics Medicine, Services Hospital, Lahore from 1st January 2018 to 30th June 2018. Methodology: Ninety children were enrolled. Demographic information like name, age, gender, weight of child was noted. Complete blood count, echocardiography and chest X-ray were done. Children underwent assessment for presence of causes of congestive heart failure. Results: Fifty six (62.22%) were between 2-30 months of age whereas 34 (37.78%) were between 31-60 months of age with mean age 29.4±12.47 months. There were 40 (44.44%) males and 50 (55.56%) females. The causes of CCF were acute myocarditis in 39 (43.33%), congenital heart disease in 31 (34.44%) and severe anemia in 20 (22.33%). Conclusion: Acute myocarditis is one of the common causes of congestive heart failure in children aftersevere anemiaand congenital heart disease. Keywords: Congestive heart failure, Common causes, Acute myocarditis, Congenital heart disease, Severe anemia

B type natriuretic peptide (BNP) as diagnostic and prognostic biomarker in children with congestive heart failure

Background: Pediatric acute heart failure is now being increasingly recognized as an important source of healthcare resource utilization. B-type natriuretic peptide (BNP) continues to be the dominant biomarker in pediatric heart failure. This study aimed to prove the role of BNP in diagnosis and prognosis of congestive heart failure in children. Method: This case control study was performed in Zagazig University Hospitals and include 60 infants and children who divided into 2 groups, group 1 consists of 30 children diagnosed by congestive heart failure and group 2 consists of 30 age and sex-matched apparently healthy children. Serum BNP level measured for both groups with assessment to the cardiac function, CBC, CRP and serum creatin level. Result: BNP and is significantly higher among CHF patients compared to controls. BNP is found to be higher in patients with sever heart failure compared to moderate and mild HF patients with significance correlation. BNP is found to be higher among congestive heart disease patients with sensitivity 93.3% and specificity 76%. BNP is a significant independent diagnostic parameter for CHF. BNP is found to be non-significant prognostic factors for children with CHF. Conclusion: BNP continues to be the dominant biomarker in pediatric heart failure. BNP is a significant diagnostic marker in diagnosis of heart failure, while it found to be non-significant prognostic factor in CHF.

Beta-blockers for congestive heart failure in children.

Beta-blockers are an essential part of standard therapy in adult congestive heart failure and therefore, are expected to be beneficial in children. However, congestive heart failure in children differs from that in adults in terms of characteristics, aetiology, and drug clearance. Therefore, paediatric needs must be specifically investigated. This is an update of a Cochrane review previously published in 2009. To assess the effect of beta-adrenoceptor-blockers (beta-blockers) in children with congestive heart failure. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and LILACS up to November 2015. Bibliographies of identified studies were checked. No language restrictions were applied. Randomised, controlled, clinical trials investigating the effect of beta-blocker therapy on paediatric congestive heart failure. Two review authors independently extracted and assessed data from the included trials. We identified four new studies for the review update; the review now includes seven studies with 420 participants. Four small studies with 20 to 30 children each, and two larger studies of 80 children each, showed an improvement of congestive heart failure with beta-blocker therapy. A larger study with 161 participants showed no evidence of benefit over placebo in a composite measure of heart failure outcomes. The included studies showed no significant difference in mortality or heart transplantation rates between the beta-blocker and control groups. No significant adverse events were reported with beta-blockers, apart from one episode of complete heart block. A meta-analysis of left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) data showed a very small improvement with beta-blockers. However, there were vast differences in the age, age range, and health of the participants (aetiology and severity of heart failure; heterogeneity of diagnoses and co-morbidities); there was a range of treatments across studies (choice of beta-blocker, dosing, duration of treatment); and a lack of standardised methods and outcome measures. Therefore, the primary outcomes could not be pooled in meta-analyses. There is not enough evidence to support or discourage the use of beta-blockers in children with congestive heart failure, or to propose a paediatric dosing scheme. However, the sparse data available suggested that children with congestive heart failure might benefit from beta-blocker treatment. Further investigations in clearly defined populations with standardised methodology are required to establish guidelines for therapy. Pharmacokinetic investigations of beta-blockers in children are also required to provide effective dosing in future trials.

Serum Level of Heart Type Fatty Acid Binding Protein Before and after Treatment of Congestive Heart Failure in Children

Background: Heart failure (HF) in children is a clinical and pathophysiological syndrome that results from ventricular dysfunction, volume or pressure overload, either alone or in combination. This study aimed to estimate serum level of H-FABP before and after treatment of congestive heart failure, and correlate its level with severity of the disease. Patients and methods: The study was cohort control study. It included 30 infants and children; their ages ranged from two months to four years with heart failure diagnosed clinically and were admitted to Cardiology Unit of Pediatric Department, at Zagazig University Hospitals during the period from November 2017 to April 2018. They were divided into four groups, first group aged (2-12 month), second group (13-24 m), third group (25-36 m) and fourth group (37-48 m). Echocardiographic assessment of the heart was done using conventional Doppler echocardiography. Serum heart type fatty acid binding protein (H-FABP) level (estimated on patient admission and 1 week after treatment) was determined by quantitative sandwich enzyme linked immunosorbent assay (ELISA) technique. Results: There was a significant difference in the serum level of H-FABP in our patients before treatment (2.156 ± 1.156 ng/ml) compared with after treatment (0.882 ± 0.716 ng/ml). There was a significant positive correlation between serum H-FABP level and Ross classification. Conclusion: H-FABP may be used as diagnostic and prognostic predictor of adverse outcome in children with heart failure.

Serum Level of Heart Type Fatty Acid Binding Protein Before and after Treatment of Congestive Heart Failure in Children

Background: Heart failure (HF) in children is a clinical and pathophysiological syndrome that results from ventricular dysfunction, volume or pressure overload, either alone or in combination. This study aimed to estimate serum level of H-FABP before and after treatment of congestive heart failure, and correlate its level with severity of the disease. Patients and methods: The study was cohort control study. It included 30 infants and children; their ages ranged from two months to four years with heart failure diagnosed clinically and were admitted to Cardiology Unit of Pediatric Department, at Zagazig University Hospitals during the period from November 2017 to April 2018. They were divided into four groups, first group aged (2-12 month), second group (13-24 m), third group (25-36 m) and fourth group (37-48 m). Echocardiographic assessment of the heart was done using conventional Doppler echocardiography. Serum heart type fatty acid binding protein (H-FABP) level (estimated on patient admission and 1 week after treatment) was determined by quantitative sandwich enzyme linked immunosorbent assay (ELISA) technique. Results: There was a significant difference in the serum level of H-FABP in our patients before treatment (2.156 ± 1.156 ng/ml) compared with after treatment (0.882 ± 0.716 ng/ml). There was a significant positive correlation between serum H-FABP level and Ross classification. Conclusion: H-FABP may be used as diagnostic and prognostic predictor of adverse outcome in children with heart failure.

Congestive Heart Failure in Children.

Congestive heart failure is a final common clinical pathway for several diseases in childhood, such as familial cardiomyopathy, viral myocarditis, inborn errors of metabolism, and autoimmune disorders. Early identification and treatment can reduce symptom severity and may affect outcomes. In this review, the clinical characteristics of pediatric heart failure are described, and the initial diagnostic evaluation is outlined. Evidence-based heart failure treatment strategies at various clinical stages are discussed in detail, including the management of acute decompensated heart failure.

R-Wave Modified Tissue Doppler Imaging Myocardial Performance Index for the Assessment of Cardiac Function in Children with Congestive Heart Failure: A Feasibility Study.

BackgroundThe aim of this study was to evaluate the feasibility of an R-wave modified tissue Doppler imaging (TDI) myocardial performance index (MPI), or MPI TDI-R, for the assessment of cardiac function in children with congestive heart failure (CHF).Material/MethodsForty children with CHF and 40 normal children were evaluated using the modified pediatric Ross heart failure grading system. TDI recorded the spectrum of diastolic function at the mitral valve annulus to measure the MPI. Twelve-lead electrocardiogram (ECG) measured the R-wave in the QRS complex, resulting in the modified MPI TDI-R. Correlation between the MPI TDI-R, other echocardiographic indices, and the Ross heart failure grades were analyzed, with reproducibility analysis.ResultsCompared with normal children, the MPI TDI and MPI TDI-R were significantly increased in the pediatric CHF group (P<0.01). The MPI TDI-R was significantly correlated with other indices of cardiac function and Ross grading for CHF in children (r=0.769). The MPI TDI-R showed good correlation with the findings of the MPI TDI, calculated by traditional methods. Receiver-operating characteristic (ROC) curve analysis showed that the MPI TDI-R had a sensitivity of 67.5%, and a specificity of 97.5%. The reproducibility of the MPI TDI-R was confirmed to be superior when compared with the non-modified MPI TDI.ConclusionsThis feasibility study showed that the modified MPI TDI-R, formed by combining the MPI TDI with synchronous surface ECG measurements, was simple to perform, reproducible, and provided a specific index for the assessment of cardiac function in children with CHF.

Study of some electrocardiographic and echocardiographic data in toddelers and children with primary glomerulonephropathy

Background and Objective: Primary glomerulonephropathy mainly acute poststreptococcal glomerulonephritis (APSGN) is the most common cause of hypertensive heart failure in the pediatric age as APSGN may involve various systems including cardiovascular system. There are few research publications on electrocardiographic (ECG) and echocardiographic (two-dimensional [2D]-echo) data in childrenwith primary glomerulonephropathy. The aim is to study some ECG and 2D-echo data in Egyptian pediatric patients with ANS). Subjects and Methods: Sixty children with ANS were included and subjected to clinical, laboratory, ECG for corrected QT (QTc) interval and 2D echocardiographic study on admission and repeated at 6 and 12 weeks using GE Vivid 7 (GE Medical System, Horten, Norway with a 3.5-MHz multifrequency transducer) to measure left ventricular ejection fraction (LVEF), left atrium to aorta ratio and E/A ratio. Results: Prolonged QTc interval was reported in 22 patients (37%), of whom 18 had hypertension. Fourteen of the 60 children had LVEF 2 and E/A ratio more than two. LVEF became within normal values by 1½ month (6 weeks) in 12 patients, two become normal by three months of follow-up. Four (28.6%) from 14 children with low LVEF had normal arterial blood pressure. All the 14 children had completely recovered on follow-up period of 3 months. Conclusion: Changes in ECG and echo data which were reported in the acute phase of ANS appear to be temporary (transient) as they became within normal values in almost all children by 12 weeks period of follow-up. Although elevated blood pressure was the most common etiology of congestive heart failure in children with ANS, the impact of primary myocardial functional disturbance could also be put into consideration.

Congestive heart failure in children with pneumonia and respiratory failure.

Congestive heart failure (CHF) is one of the most common cardiac complications of pneumonia in adulthood leading to increased risk of morbidity and mortality. Little is known, however, of CHF and pneumonia in children. The aim of this study was therefore to investigate the characteristics and factors associated with CHF in under-5 children with pneumonia and respiratory failure. A retrospective cohort was conducted in hospitalized patients aged 2-59months with community-acquired pneumonia and respiratory failure from June 2011 to June 2014 at Suratthani Hospital, Thailand. The characteristics, therapeutic strategy, and clinical outcomes of CHF were reviewed. Baseline characteristics and basic laboratory investigations on admission were compared between the CHF and non-CHF groups. Of 135 patients, 14 (10%) had CHF. Compared with patients without CHF, the CHF group had prolonged intubation and hospital stay and high rates of associated complications such as ventilator-associated pneumonia, sepsis, shock, and 30day mortality. CHF was significantly associated with certain characteristics, including male sex and bacterial pneumonia. Pneumonia with respiratory failure is associated with CHF even in healthy children without cardiac risks. The awareness and early recognition of CHF, particularly in male, and bacterial pneumonia, is important in order to provide immediate treatment to reduce complications.

Hypertonic saline with furosemide for diuretic resistant congestive heart failure in an infant

Hypertonic saline with intravenous furosemide therapy for diuretic resistant congestive heart failure has been postulated in adults [ 1 Liszkowski M. Nohria A. Rubbing salt into wounds: hypertonic saline to assist with volume removal in heart failure. Curr. Heart Fail. Rep. 2010; 7: 134-139 Crossref PubMed Scopus (17) Google Scholar , 2 Vecchis R.D. Esposito C. Ariano C. Cantatrione S. Hypertonic saline plus i.v. furosemide improve renal safety profile and clinical outcomes in acute decompensated heart failure. Herz. 2015; 40: 423-435 Crossref PubMed Scopus (30) Google Scholar , 3 Paterna S. Di Pasquale P. Parrinello G. Amato P. Cardinale A. Follone G. Giubilato A. Licata G. Effects of high-dose furosemide and small-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as a bolus, in refractory congestive heart failure. Eur. J. Heart Fail. 2000; 2: 305-313 Crossref PubMed Scopus (96) Google Scholar ]. Low-volume hypertonic saline administration transiently improves hemodynamics, enhances natriuresis and preserves renal function [ [1] Liszkowski M. Nohria A. Rubbing salt into wounds: hypertonic saline to assist with volume removal in heart failure. Curr. Heart Fail. Rep. 2010; 7: 134-139 Crossref PubMed Scopus (17) Google Scholar ]. However, concerning congestive heart failure in children, there is little evidence about the efficacy of hypertonic saline therapy. This report presents an infant who recovered from severe congestive heart failure by hypertonic saline therapy.

(1138) - Nutritional Status of Children Undergoing Heart Transplantation at the Heart Institute of São Paulo (Incor) between 2013-2015

Congestive heart failure in children presents as an increased risk for malnutrition, due to cardiac cachexia and increased metabolic demand. The effect of malnutrition on adults undergoing heart transplantation (HTx) has been well-studied; however there are few data on pediatric population. The goal of our study was to analyse the nutritional status of children undergoing HTx at the Heart Institute of Sao Paulo (Incor), Brazil. We conducted a retrospective analysis of the medical records of all pediatric patients who underwent HTx between 2013 and 2015. Fifty-five patients were submitted to heart transplantation (28 girls and 27 boys), with an average age of 10 years. The average height was 127 cm ( median 131 cm, standard deviation (stdev) 32 cm), and the average Z-score according to world health organization (WHO) growth charts was -1,12 (median -0,97; stdev 2,01). The average body mass index Z-score according to world health organization (WHO) growth charts was -1,75 (median -0,8; stdev 1,7). We used the WHO definition for thinness, which is BMI Zscore<-2. There were 15 patients (27%) with diagnosis of thinness, of whom 7 had severe thinness (BMI Zscore<-3). There were no obese patients. Wasting was present in 18% of patients with congenital heart disease and 35% of patients with cardiomyopathy. There were 6 boys whose BMI Zscore was below -2, and 9 girls were under the same condition. Among the patients who died after heart transplantation, 31% were thin or severely thin before the procedure, while among those who survived heart transplantation, 28% were thin or severely thin. The data shows a tendency towards malnutrition at the time of HTx, which may impact on the outcome of the procedure.

Çocuklarda Konjestif Kalp Yetersizliği

Çocuklarda Konjestif Kalp Yetersizliği

Beta-blockers for congestive heart failure in children.

Beta-blockers are an essential part of standard therapy in adult congestive heart failure and therefore, are expected to be beneficial in children. However, congestive heart failure in children differs from that in adults in terms of characteristics, aetiology, and drug clearance. Therefore, paediatric needs must be specifically investigated. This is an update of a Cochrane review previously published in 2009. To assess the effect of beta-adrenoceptor-blockers (beta-blockers) in children with congestive heart failure. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and LILACS up to November 2015. Bibliographies of identified studies were checked. No language restrictions were applied. Randomised, controlled, clinical trials investigating the effect of beta-blocker therapy on paediatric congestive heart failure. Two review authors independently extracted and assessed data from the included trials. We identified four new studies for the review update; the review now includes seven studies with 420 participants. Four small studies with 20 to 30 children each, and two larger studies of 80 children each, showed an improvement of congestive heart failure with beta-blocker therapy. A larger study with 161 participants showed no evidence of benefit over placebo in a composite measure of heart failure outcomes. The included studies showed no significant difference in mortality or heart transplantation rates between the beta-blocker and control groups. No significant adverse events were reported with beta-blockers, apart from one episode of complete heart block. A meta-analysis of left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) data showed a very small improvement with beta-blockers.However, there were vast differences in the age, age range, and health of the participants (aetiology and severity of heart failure; heterogeneity of diagnoses and co-morbidities); there was a range of treatments across studies (choice of beta-blocker, dosing, duration of treatment); and a lack of standardised methods and outcome measures. Therefore, the primary outcomes could not be pooled in meta-analyses. There is not enough evidence to support or discourage the use of beta-blockers in children with congestive heart failure, or to propose a paediatric dosing scheme. However, the sparse data available suggested that children with congestive heart failure might benefit from beta-blocker treatment. Further investigations in clearly defined populations with standardised methodology are required to establish guidelines for therapy. Pharmacokinetic investigations of beta-blockers in children are also required to provide effective dosing in future trials.

Angiotensin-converting enzyme inhibitors for congestive heart failure in children

Angiotensin-converting enzyme inhibitors for congestive heart failure in children

Serum Level of Heart-Type Fatty Acid Binding Protein (H-FABP) Before and After Treatment of Congestive Heart Failure in Children.

Remodeling of the heart following injury affects the morbidity and mortality in children presented with heart failure (HF). Heart-type fatty acid binding protein (H-FABP) is a novel biomarker that could be of help to predict the prognosis and risk stratification in those children. We aimed to evaluate the diagnostic and prognostic value of H-FABP in children with heart failure before and after treatment. The study was conducted as a prospective cohort study. It included 30 children with HF as a patient group and 20 healthy children matched for age and sex as a control group. Echocardiographic assessment of the heart was done using conventional Doppler echocardiography. Serum levels of (H-FABP) were measured using enzyme-linked immunosorbent assay before and after treatment of HF. All patients were observed during follow-up period of 3months. There was a significant difference in the serum level of H-FABP in our patients before treatment (5.278±3.253ng/ml) compared with after treatment (2.089±0.160ng/ml) with significant difference compared with the control group. There was a significant increase in the serum level of H-FABP with increase in the severity of heart failure according to Ross classification. Significant increase in the H-FABP was associated with adverse outcome. Serum levels of H-FABP strongly correlated with clinical and echocardiographic assessment of LV performance of children with HF, and its levels significantly increased in children with adverse outcome suggesting its value as a useful diagnostic and prognostic predictor (with high sensitivity and specificity).

Preoperative NT-proBNP values in patients with atrioventricular septal defect and its role as a predictor of early postoperative course.

Atrioventricular septal (AVSDC) defect presents by excessive pulmonary blood flow and congestive heart failure in children. This study was designed to identify and compare N-terminal pro-brain natriuretic peptide (NT-proBNP) values in complete and incomplete form at the time of surgery, and evaluation of postoperative course. The prospective study included thirty-one patients with complete and fifteen with intermediate forms, undergoing surgery in the period from May 2009 to January 2014. Pre- and post-operative variables were statistically analyzed. The median value of NT-proBNP was 1420.0 pg/mL, with elevated levels in complete form (1656.0 vs 488.0 pg/mL, p < 0.001); age and weight with negative correlation. Other preoperative variables (genetic disorder, atrioventricular valve regurgitation, borderline ventricle) were not significant. Higher incidence of postoperative variables was present in complete form, namely mechanical ventilation (p < 0.03), dose and length of vasopressors (p < 0.002), ICU stay (p < 0.04), and complications (p < 0.05). NT-proBNP analysis as a predictor of postoperative course showed an association with longer ventilatory (> 48 hours) and inotropic forms of support, ICU stay, and presence of infection. NT-proBNP value might be helpful in the decision-making process of early surgical treatment of complete form of AVSDC, and useful as a predictor of early post-operative course (Tab. 4, Fig. 3, Ref. 14).

Sildenafil for Noncompaction Cardiomyopathy Treatment in a Child: Case Report

Congestive heart failure (CHF) occurs when the heart can no longer maintain the baseline metabolic demand triggered by physiological venous pressure. In the pediatric population, it corresponds to a complex entity with multiple etiologies, depending on the age group assessed, being mainly associated with congenital structural malformations, cardiomyopathies, or secondary to arrhythmogenic, infectious, ischemic, toxic or infiltrative events1. The incidence of CHF in children also varies according to the underlying condition, ranging from 15% to 25% in patients with congenital heart defects. In structurally normal hearts, cardiomyopathy is the major factor associated with CHF, with a 40% incidence of CHF reported in those patients1. Isolated noncompaction cardiomyopathy is a rare disease, whose incidence in the general population ranges from 0.014% to 1.3%. It might result from a failure in compaction of the ventricular myocardium between weeks 5 and 8 of the embryonic life, leading to the persistence of myocardial trabeculations and deep recesses, which communicate with the ventricular cavity, generating myocardial thickening in two distinct layers (compacted and noncompacted). Initially reported in the pediatric population or with a congenital cardiopathy, it also affects adults with no other heart disease2,3. This failure in the regression of embryonic sinusoids is postulated to be due to the extremely high pressures that the ventricles undergo in that developmental period. However, the literature has reported a genetic aspect emphasizing the relationship of the disease with different genes, such as the mutation of gene G4.5 in families with severe infantile noncompaction cardiomyopathy, mutations P121L, CYPHER/ZASP, E101K, and a locus containing the disease gene in chromosome 11p153. The major complications of patients with noncompaction cardiomyopathy are pulmonary thromboembolism, arrhythmias and CHF3. In addition to the usual treatment of CHF, new classes of drugs, such as the phosphodiesterase type 5 (PDE-5) inhibitors, have been studied4. They are currently used for the treatment of erectile dysfunction and pulmonary arterial hypertension, and began to be studied for the treatment of CHF after the demonstration of higher PDE-5 expression in myocytes and vascular muscle cells, as well as of markers of oxidative stress in patients with CHF5. We report, for the first time, the clinical and laboratory findings of a patient with noncompaction cardiomyopathy after the addition of sildenafil (PDE-5 inhibitor) to the usual treatment.

Particular aspects in Pediatric Congestive Heart Failure

Congestive heart failure (CHF) assumes high material costs and a significant death rate. In the U.S., CHF is a major public health problem, with more than 900.000 hospitalizations per year and more than 250.000 deaths annually. Most CHF cases occur in adults, so that the statistics presented, primarily interested in the adult population. In children, the scope of the problem is less well defined. Data from the American Registry of pediatric cardiomyopathy suggest an annual incidence of 1.13 per 100.000 children cardiomyopathy, most developing CHF. The mortality rate at 2 years after diagnosis is 13.6 % in the forms of dilated cardiomyopathy [1]. CHF in children presents important charactersitic features from the adult congestive failure, from the physiopathological and mostly from the etiopathogenical point of view. While the congestive heart failure at adult age is due to ischemia in 60-70 % of cases, congestive heart failure at children is, in most cases, a consequence of either congenital heart diseases (CHD) which remained unoperated, undergone a palliative operation or presented postsurgery complications or of one cardiomyopathy. Chronic CHF may occur in children with biventricular circulation (systolic or diastolic dysfunction), into cardiac structural abnormalities with right ventricle as systemic ventricle and in the so-called univentricular heart. We mark the fact that the incidence of the congenital heart diseases is of 8/1000 alive new-born children and that, in Romania, are born, annually, between 800 and 1300 children having a CHD. Out of these more then 20 % develop at least once congestive cardiac failure during their first childhood, in accordance with our information. So far have been developed excellent guidelines for CHF diagnosis and therapy in adult patients, but the same can not be said about pediatric CHF. Given the significant differences between adults, children and adolescents with CHF, there is little reason to believe that the adult guidelines are directly applicable to children. However, many attitudes in the diagnosis and therapy of pediatric CHF are extrapolated from adult. Most of the studies concerning the paediatric CHF diagnosis and therapy are extended to adult cardiac failure although it is proven the absence of complet propinquity. Diagnosis and prognosis issue: So far there are few criterions to clearly define the paediatric CHF, especially at small age; its assessment and prognosis evaluation. At present, the pediatric CHF diagnosis is based especially on clinical assessment, and on ultrasound functional findings. The latter, is mainly used to evaluate the left ventricular (LV) functional parameters since the diastolic disorder is difficult to assess Clinically, the functional evaluation of CHF at children age is made accordind to the Ross classification (an adaptation of the NYHA classification for children). Ross classification allows the evaluation of the state of severity at infant and small child. It is used on daily basis by the Canadian Cardiovascular Society as the official CHF evaluation system in the case of pediatric patients and it has been assumed by numerous pediatric cardiologists, including us. It is important to emphasize that this classification system includes, also, the growth failure, as another indicator in the assessment of the child’s CHF. The echocardiographic parameters most frequently used for the global evaluation of the left ventricular systolic function are: the shortening fraction, the ejection fraction measured in TM and 2D or through Doppler examination. These indicators depend on the cardiac loading conditions and do not reflect the myocardic fibre intrinsic value. The increasing filling pressures in the left ventricule represents the common path towards CHF, no matter its etiology. For this reason, the left ventricle diastolic function is an important step in the diagnosis and therapy assessment process. The 2D and TM findings have a low specificity and, as a result, are no loger in use. During the last years, the Doppler ultrasound examination has proved to be very useful in noninvasive evaluation of the left ventricular diastolic function and it is, in the same time, very accesible in the adult cardiology as well. Nowadays, most of the information regardind the left ventricular protodiastola is drawn from the transmitral tide and the myocardic velocity evaluation using tissuue Doppler [2,3]. The tissue Doppler is still rarely used in paediatrics and the physiological standards have not been established yet. However, the few publications on this subject consider tissue Doppler imaging as rewarding in paediatric cardiology [4,5] and , for all that, one of our research objectives is to evaluate, using tissue Doppler, the left ventricular diastolic function in children with CHF. Various biological markers have been considered, during the past few years, as possible indicators of CHF. The most important of them are the compounds derived from compensatory neurohumoural activity such as natriuretic peptides. Its blood concentration level varies in correlation with the overloading volume or pressure degree in the heart.

The Role of N-Terminal Pro-B-Type Natriuretic Peptide in the Diagnosis of Congestive Heart Failure in Children - Correlation With the Heart Failure Score and Comparison With B-Type Natriuretic Peptide -

Both B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) are useful biomarkers for the assessment of congestive heart failure (CHF) in adults. The purpose of this study was to determine whether BNP and NT-proBNP levels could be used to stratify the severity of CHF in children. The study comprised 181 children with CHF and 232 healthy children aged from 4 months to 14 years who were categorized into CHF grades I, II, III and IV according to the modified Ross scoring system. The plasma BNP and serum NT-proBNP levels were significantly correlated with increasing CHF grades. The NT-proBNP levels were significantly different among the 4 CHF grades. However, only 2 significant differences were observed in the BNP levels between each CHF grade. NT-proBNP testing with cut-off points of >438 pg/ml (> or =grade II), >1,678 pg/ml (> or =grade III) and >7,734 pg/ml (grade IV) in the patients below 3 years of age, and >295 pg/ml (> or =grade II), >1,545 pg/ml (> or =grade III) and >3,617 pg/ml (grade IV) in those above 3 years of age was determined to be highly sensitive and specific by receiver operating characteristic analysis. The blood levels of BNP and NT-proBNP therefore reflect the severity of CHF in children. In particular, NT-proBNP is a useful biomarker for evaluating CHF in children.