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Elevation of atrial natriuretic peptide prohormone. Hemodynamic background of the elevation of N-terminal natriuretic peptide prohormone in children with congenital heart disease

Published online by Cambridge University Press:  19 August 2008

Henrik Holmström ,
Christian Hall ,
Oddvar Stokke ,
Harald Lindberg  and
Erik Thaulow
Henrik Holmström*
Affiliation:
Department of Pediatrics, National Hospital (Rikshospitalet), N-0027 Oslo, Norway
Christian Hall
Affiliation:
Institute for internal medicine research, National Hospital (Rikshospitalet), N-0027 Oslo, Norway
Oddvar Stokke
Affiliation:
Institute of clinical biochemistry, National Hospital (Rikshospitalet), N-0027 Oslo, Norway
Harald Lindberg
Affiliation:
Thoracal and cardiovascular surgery unit, National Hospital (Rikshospitalet), N-0027 Oslo, Norway
Erik Thaulow
Affiliation:
Department of Pediatrics, National Hospital (Rikshospitalet), N-0027 Oslo, Norway
*
Henrik Holmström, Barnehjerteseksjonen, Rikshospitalet (National hospital), N-0027 Oslo, Norway. Tel: 47-22 86 90 95; Fax: 47-22 86 9101; e-mail: henrik.holmstrom@rh.uio.no
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Abstract

We postulated previously that variables related to pulmonary flow are independent predictors of levels of atrial natriuretic peptide in children with congenital heart disease. The aim of this study was to test this hypothesis in relation to other hemodynamic and clinical variables.

During catheterization we measured the levels of plasma N-terminal atrial natriuretic peptide prohormone in the plasma of 68 children with congenital heart disease. All had undergone complete clinical, echocardiographic and invasive hemodynamic investigations. The influence on the prohormone was analyzed for 10 different variables in a multiple linear regression model. The variability could be explained in large parts (adjusted R2 = 77.2%) by variations in atrial pressures or sizes, together with the degree of excessive pulmonary blood flow and signs of heart failure.

A value for atrial natriuretic peptide prohormone above 800 pmol/1 predicted hemodynamic imbalance (defined as elevated pressures in left or right atrium or the pulmonary arteries, and/or Qp/Qs > 1.5) with a specificity of 94%, a sensitivity of 73%, a positive likelihood ratio of 12.2, and a negative likelihood ratio of 0.29.

In conclusion, variables related to pulmonary blood flow are influential determinants of the levels of atrial natriureic peptide in children with congenital heart disease. Atrial pressures, and symptoms of heart failure are also of major importance.

Keywords

Atrial natriuretic peptidecongenital heart diseasechildrenhemodynamicsprohormone
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 2 , March 1999 , pp. 141 - 149
Copyright
Copyright © Cambridge University Press 1999

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