Usefulness of Various Plasma Biomarkers for Diagnosis of Heart Failure in Children with Single Ventricle Physiology

摘要

Children with single ventricle physiology have increased ventricular work and are at greater risk for developing heart failure than other children with congenital heart disease. However, diagnosis of heart failure is difficult because few objective measures have been validated in this cohort. Plasma proteins have been identified as biomarkers of heart failure in adults with structurally normal hearts. However, whether these similarly correlate with heart failure in children with single ventricle physiology is unknown, as the etiology of adult heart failure is typically ischemic heart disease, whereas heart failure in these children is presumed to be due to primary myocardial dysfunction. We conducted a single site cross-sectional observational study of young single ventricle patients. Clinical heart failure was defined as a Ross score >2. The association of several candidate biomarkers with heart failure was assessed using logistic regression and Receiver Operator Characteristic (ROC) curves. Nine of 29 included children (31%) were in clinical heart failure. A doubling of plasma B-type natriuretic peptide was associated with an odds ratio for heart failure of 2.17. The area under the ROC curve was 80.3%. A threshold value of ≥30 pg/mL showed both sensitivity and specificity for heart failure. Three other candidate biomarkers were not found to be associated with clinical heart failure in this sample. In conclusion, plasma B-type natriuretic peptide is a sensitive biomarker for clinical heart failure in young children with single ventricle heart disease. Use of this plasma biomarker may facilitate detection of heart failure in these complex patients.