The Clinical Significance Of Brain Natriuretic Peptide In Evaluating Acute Decompensated Heart Failure And Ventricular Remodeling In Children With Dilated Cardiomyopathy

Objective To study the clinical value of serum brain natriuretic peptide(BNP)in the assessment of acute decompensated heart failure(ADHF)and ventricular remodeling in children with dilated cardiomyopathy.And to explore the affecting factors of prognosis of DCM in children.Method(1)Forty children with dilated cardiomyopathy combing acute decompensated heart failure were enrolled in this study,who received diagnosis and treatment In Children’s Hospital of Chongqing Medical University from January 2004 to August 2016,and their data including normal information,heart function classification(Modified ROSS score),serum test results(BNP,CK-MB,Troponin),echocardiography(LVEF,LVEDd,LVEDs,IVSD),Electrocardiogram,chest X-ray and so on,were collected.The changes of BNP and the correlation between BNP and the corresponding indexes such as Modified ROSS score,LVEF,LVEDd and IVSD were analyzed retrospectively.(2)And follow up 40 cases of dilated cardiomyopathy in children with hormone usage and survival.In order to gain prognostic factors,we first use Univariate analysis and then further Logistic regression analysis to single factors which have statistical differences.Result(1)There were significant differences in the Modified ROSS score,BNP,LVEF and LVEDd before and after treatment in ADHF.Before treatment,there was a positive correlation between BNP and Modified ROSS score(R = 0.936,P <0.01),negative correlation with LVEF(R=-0.838,P<0.01),slight correlation with LVEDd(R =-0.318,P = 0.046 <0.05),and negatively correlated with IVSD(R =-0.551,P <0.01).After treatment the BNP is still positively correlated with the Modified ROSS score(R=0.959,P<0.01),but there is no obvious correlation between BNP and LVEF,LVEDd,IVSD representing left ventricular remodeling index.There was a certain correlation between BNP and ventricular remodeling before treatment,but no significant correlation was found after the treatment.After ADHF was improved,the serum BNP level and the Modified ROSS score significantly decreased,and the LVEF increased,But when the heart failure symptoms were significantly controled and BNP levels were lower even normal,the ventricular reverse remodeling is no significant improvement.(2)According to the follow-up results were divided into three groups including follow-up group,death group and survival group.The results of univariate analysis showed that the age(months),the Modified ROSS score,BNP,cardiothoracic ratio,CK-MB and troponin were higher in the death group than in the survival group,and the LVEF was lower than survival group,whether combining with arrhythmia and usage of hormone therapy were statistically significant differences.Multivariate Logistic regression analysis showed that the Modified ROSS score,BNP,cardiothoracic ratio,whether combining with arrhythmia were the prognostic factors for DCM in children.Conclusion(1)Serum BNP levels in children with dilated cardiomyopathy are closely related to the severity of ADHF,the serum level of BNP combining with the Modified ROSS score and LVEF has important clinical value in evaluating the development and progression of ADHF,While the level of BNP in children with dilated cardiomyopathy assessment of ventricular remodeling value will to be further.(2)To assess the prognosis of children with DCM,It needs comprehensive analysis merging BNP,the Modified ROSS score,cardiothoracic ratio,and whether combining with arrhythmia.Age of onset,CK-MB,troponin,LVEF,whether the usage of hormone therapy having little effect on the prognosis,it can only be used to estimate the prognosis as one of the indicators.