Pediatric Cardiology

, Volume 35, Issue 5, pp 879–887

Factors Associated with Serum B-Type Natriuretic Peptide in Infants with Single Ventricles


    • Department of PediatricsMedical University of South Carolina
  • Victor Zak
    • New England Research Institutes
  • Daphne Hsu
    • Division of CardiologyChildren’s Hospital at Montefiore
  • James Cnota
    • Department of CardiologyCincinnati Children’s Hospital
  • Steven D. Colan
    • Department of CardiologyBoston Children’s Hospital
  • David Hehir
    • Department of PediatricsMedical College of Wisconsin
  • Paul Kantor
    • Department of CardiologyHospital for Sick Children
  • Jami C. Levine
    • Department of CardiologyBoston Children’s Hospital
  • Renee Margossian
    • Department of CardiologyBoston Children’s Hospital
  • Marc Richmond
    • Department of CardiologyChildren’s Hospital of New York
  • Anita Szwast
    • Department of CardiologyChildren’s Hospital of Philadelphia
  • Derek Williams
    • Department of CardiologyBrenner Children’s Hospital
  • Richard Williams
    • Department of PediatricsUniversity of Utah
  • Andrew M. Atz
    • Department of PediatricsMedical University of South Carolina
Original Article

DOI: 10.1007/s00246-014-0872-z

Cite this article as:
Butts, R.J., Zak, V., Hsu, D. et al. Pediatr Cardiol (2014) 35: 879. doi:10.1007/s00246-014-0872-z


Data regarding the value of B-type natriuretic peptide (BNP) measurements in infants with a single-ventricle (SV) physiology are lacking. This analysis aimed to describe the BNP level changes in infants with an SV physiology before and after superior cavopulmonary connection (SCPC) surgery. Levels of BNP were measured by a core laboratory before SCPC (at 5.0 ± 1.6 months) and at the age of 14 months during a multicenter trial of angiotensin-converting enzyme inhibition therapy for infants with SV. Multivariable longitudinal analysis was used to model the associations between BNP levels and three sets of grouped variables (echocardiography, catheterization, growth). Multivariable analysis was performed to assess associations with patient characteristics at both visits. Associations between BNP levels and neurodevelopmental variables were investigated at the 14 month visit because neurodevelopmental assessment was performed only at this visit. The BNP level was significantly higher before SCPC (n = 173) than at the age of 14 months (n = 134). The respective median levels were 80.8 pg/ml (interquartile range [IQR], 35–187 pg/ml) and 34.5 pg/ml (IQR, 17–67 pg/ml) (p < 0.01). A BNP level higher than 100 pg/ml was present in 72 subjects (42 %) before SCPC and in 21 subjects (16 %) at the age of 14 months. In the 117 patients who had BNP measurements at both visits, the median BNP level decreased 32 pg/ml (IQR, 1–79 pg/ml) (p < 0.01). In the longitudinal multivariable analysis, higher BNP levels were associated with a higher end-systolic volume z-score (p = 0.01), a greater degree of atrioventricular (AV) valve regurgitation (p < 0.01), a lower weight z-score (p < 0.01), and a lower length z-score (p = 0.02). In multivariable analyses, a higher BNP level at the age of 14 months was associated with arrhythmia after SCPC surgery (p < 0.01), a prior Norwood procedure (p < 0.01), a longer hospital stay after SCPC surgery (p = 0.04), and a lower Bayley psychomotor developmental index (p = 0.02). The levels of BNP decreases in infants with SV from the pre-SCPC visit to the age of 14 months. A higher BNP level is associated with increased ventricular dilation in systole, increased AV valve regurgitation, impaired growth, and poorer neurodevelopmental outcomes. Therefore, BNP level may be a useful seromarker for identifying infants with SV at risk for worse outcomes.


B-type natriuretic peptide BNP Single-ventricle physiology Superior cavopulmonary connection surgery Angiotensin-converting enzyme inhibition therapy SCPC Ventricular dilation

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© Springer Science+Business Media New York 2014