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Risk Factors for Cardiac Adverse Events in Infants and Children with Complex Heart Disease Scheduled for Bi-ventricular Repair: Prognostic Value of Pre-operative B-Type Natriuretic Peptide and High-Sensitivity Troponin T

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Abstract

Few reports have described the prognostic value of measuring both B-type natriuretic peptides (BNP) and high-sensitivity troponin T (hs-TnT) in pediatric patients with complex congenital heart disease (CHD) undergoing surgery. We assessed demographic, hemodynamic, and laboratory data, including BNP and hs-TnT levels, for the prediction of cardiac adverse events in 85 patients. Cardiac adverse events were defined as death, cardiac arrest, worsening heart failure requiring inotropic agents and/or respiratory support, and unscheduled surgery/intervention either within or after 12 months of surgery. There were 17 cardiac adverse events. Of the demographic variables, low birth weight (< 2500 g: Odds ratio [OR], 5.97; 95% confidential interval [CI] 1.48–24.0; p = 0.001) and Ross/New York Heart Association [NYHA] class (≥ 2.0) (OR 12.7; 95% CI 3.08–52.7; p = 0.0004) were strongly association with cardiac adverse events. Among hemodynamic and laboratory variables, preoperative BNP (OR 14.04; 95% CI 2.15–91.7; p = 0.001) and hs-TnT levels (OR 16.66; 95% CI 2.27–122; p = 0.002) were found to be independent risk factors. Receiver operating characteristic analysis determined BNP and hs-TnT levels of 60.9 pg/mL and 0.025 ng/mL, respectively, to be markers of high risk. Kaplan–Meier analysis demonstrated significant differences in the freedom from cardiac adverse events between Group A (BNP or hs-TnT elevated, n = 26) and Group B (both biomarkers elevated, n = 19; log-rank, p < 0.001). In conclusion, low birth weight (< 2500 g) and Ross/NYHA class ≥ 2.0 are strongly associated with cardiac adverse events. Preoperative BNP and hs-TnT also provide prognostic information in patients with complex CHD scheduled for surgery. Using both markers in combination predicts cardiac adverse events better than using either separately.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Funding

The study received no grant from any funding agency in the public, commercial, or not-profit sectors.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan

    Yoshiki Mori, Yasumi Nakashima, Sachie Kaneko, Nao Inoue & Tomotaka Murakami

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  1. Yoshiki Mori
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  2. Yasumi Nakashima
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  3. Sachie Kaneko
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Contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by YM MD and YN MD. The draft of manuscript was written by YM MD. Material preparation and data collection were performed by NI MD, SK MD, and T MD. All authors read and approved the paper.

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Correspondence to Yoshiki Mori.

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This cohort study was approved by the ethics committee of Seirei Hamamatsu General Hospital.

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Parental informed consent was obtained from all patients included in the study.

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Mori, Y., Nakashima, Y., Kaneko, S. et al. Risk Factors for Cardiac Adverse Events in Infants and Children with Complex Heart Disease Scheduled for Bi-ventricular Repair: Prognostic Value of Pre-operative B-Type Natriuretic Peptide and High-Sensitivity Troponin T. Pediatr Cardiol 41, 1756–1765 (2020). https://doi.org/10.1007/s00246-020-02437-5

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