Original Research Article
Year: 2018 | Month: June | Volume: 5 | Issue: 6 | Pages: 118-122
N Terminal Pro B Type Natriuretic Peptide as a Tool to Diagnose Hemodynamically Significant Patent Ductus Arteriosus in Older Infants
Biswarup Mukherjee1, Dr. Achyut Sarkar2, Debargha Dhua3, Saikat Bhattacharya4
1MD (Gen Medicine), DNB (Cardiology), DM (Cardiology) Associate Prof, Dept of Cardiology. NRS Medical College & Hospital. Kolkata.
2 DM Cardiology, Associate Prof. & Head of Pediatric Cardiology Unit, Institute of Cardiovascular Sciences, IPGMER & SSKM Hospital. Kolkata
3MBBS, MD, DM (Cardiology), Senior Consultant, Gouri Devi Hospital & Research Institute, Rajbandh, GT Road Durgapur-713212,West Bengal
4Post Graduate Trainee, Dept. of Community Medicine, RG Kar Medical College & Hospital, Kolkata.
Corresponding Author: Biswarup Mukherjee
ABSTRACT
B type natriuretic peptide (BNP) is a pre-pro hormone secreted from the ventricular myocardium in response to myocardial stretching due to pressure or volume overload. N terminal pro B type natriuretic peptide (NT pro BNP) is a biologically inactive form of BNP. The measurement of plasma NT pro BNP has been found to be effective in diagnosing hemodynamically significant patent ductus arteriosus (hsPDA) in neonates. The role of plasma NT pro BNP measurement in diagnosing hsPDA in older infants has not been studied much.
Objectives: To evaluate the usefulness of the measurement of plasma NT pro BNP level in diagnosing hsPDA in older infants.
Methods: The patients referred from primary or secondary level health care centres with the clinical diagnosis of PDA and our out-patient-department-basis follow up cases of PDA were enrolled into our study. All these patients were made to undergo echocardiography by expert Pediatric Cardiologist to assess the hemodynamic significance of PDA as well as to exclude other clinical mimickers of PDA. Subsequently plasma NT pro BNP of each patient of PDA was measured within one hour of echocardiographic assessment.
Results: A total number of 40 patients (3 months to 9 months of age) of PDA were evaluated. 24 out of them fulfilled the echocardiographic criteria of hsPDA. NT pro-BNP level was measured in 24 patients with hsPDA, and in 16 patients with hemodynamically insignificant PDA. The median NT pro-BNP value of infants of 3 months or older with hsPDA was 1245.0 pg/ml, range 90-7998 pg/ml, and 95th percentile was 7693.75 pg/ml. It was significantly greater than that of infants with hemodynamically insignificant PDA (p<0.0001). The area under the receiver operator characteristic (ROC) curve for the detection of hsPDA was 0.966 with 95% CI (0.914 to 1.018) which is significant (p<.0001) The measurement of plasma NT-proBNP level was highly sensitive predictor of hsPDA (sensitivity 91%; specificity 94%) at a cutoff value of 220 pg/ml.
Conclusion: The measurement of plasma NT pro BNP, in conjunction of clinical suspicion, can serve as a supplemented tool to echocardiography in diagnosing hsPDA in older infants.
Key words: natriuretic peptides, BNP, NT pro BNP, patent ductus arteriosus, hsPDA
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