WEST AFRICAN JOURNAL OF MEDICINE ORIGINAL ARTICLE

Diagnostic Usefulness of N-terminal Pro-brain Natriuretic Peptide among Children with Heart Failure in a Tertiary Hospital in Lagos, Nigeria Interet Diagnostic Du N Terminal Pro- Bnp Dans L’insuffisance Cardiaque De L’enfant Dans Un Hopital De Niveau 3 A Lagos, Nigeria E. N. Ekure*†, C. A. Okoromah†, J. N Ajuluchukwu‡, A. Mbakwem‡, J. Oladipo§ ABSTRACT BACKGROUND: N-terminal pro-brain natriuretic peptide (NTproBNP) is useful in the diagnosis and management of adult patients with heart failure. OBJECTIVE: The objective of the study was to determine the usefulness of NT-proBNP in diagnosing congestive heart failure (CHF) in children and its correlation with left ventricular ejection fraction (LVEF) and clinical heart failure score. METHODS: Plasma NT-proBNP was measured in 28 children with CHF and age matched controls. Heart failure assessment was done using modified Ross score and all had echocardiography done. RESULTS: Mean plasma NT-proBNP of children with CHF (377.86±1026.49pg/mL) was significantly higher than that of controls (353.61±328.50 pg/mL) (p 35 > 28

Physical Examination Breathing Normal Respiratory rate (respirations/min) < 1 year < 50 1 – 6 years < 35 7 – 10 years < 25 11 – 14years < 18 Heart rate (beats/min) < 1year 1 – 6years 7 – 10years 11 – 14years

< 160 < 105 < 90 < 80

160 – 170 105 – 115 90 – 100 80 – 90

> 170 > 115 > 100 > 90

Hepatomegaly

< 2cm

2 – 3cm

> 3cm

Scores for each of the 6 categories are added together. Total scores can range from 0 (no heart failure) to 12 (severe heart failure)

Table 2: Heart Diseases of the 28 Children with Congestive Heart Failure Heart disease

Male

Female Total Number of Children (%)

Ventricular septal defect

8

8

16(57.1)

Rheumatic heart disease Endocardial cushion defects

3 2

3 1

6(21.4) 3(10.7)

Tetralogy of fallot with absent pulmonary valves

1

1

2(7.1)

Aortic aneurysm

0

1

1(3.6)

14

14

28(100.0)

Total

West African Journal of Medicine Vol. 30, No. 1 January–February, 2011

31

E. N. Ekure and Associates

N-terminal Pro-brain Natriuretic Peptide

Comparison of weight and biochemical parameters between the two groups of children studied is shown in Table 4. NT-proBNP levels showed a positive correlation with the clinical heart failure score (modified Ross) (p 84 months, n (%) Mean Age (Months) Sex Male, n (%) Female, n (%)

Table 4: Comparison of Weight, Cardiac and Biochemical Parameters between Children with Congestive Heart Failure and Normal Children Variable

Weight (kg) % LVEF Ross score Hb NT-proBNP

Mean ± SD Heart failure n = 28 13.6 ± 12.0 75.64 ± 11.6 7.3 ± 2.6 12.9 ± 1.5 1377.9 ±1037.8

Normal n = 28 19.4 ± 17.8 75.64 ± 10.2 0±0 12.1 ± 1.4 353.6 ± 328.5

Mann-Whitney U Statistic 4.94 0.33 47.35 4.05 16.17

P value 0.03* 0.99