Cardiac Biomarkers of Low Cardiac Output Syndrome in the Postoperative Period After Congenital Heart Disease Surgery in Children

• Published in: Revista española de cardiología (English ed.) Vol. 70; no. 4; pp. 267 - 274
• Main Authors: Pérez-Navero, Juan L, de la Torre-Aguilar, María José, Ibarra de la Rosa, Ignacio, Gil-Campos, Mercedes, Gómez-Guzmán, Elena, Merino-Cejas, Carlos, Muñoz-Villanueva, María C, Llorente-Cantarero, Francisco J
• Format: Journal Article
• Language: English
• Published: Spain 01-04-2017
• Subjects: Adrenomedullin - metabolism; Analysis of Variance; Biomarkers - metabolism; Cardiac Output, Low - diagnosis; Cardiopulmonary Bypass - methods; Child; Child, Preschool; Female; Heart Defects, Congenital - surgery; Humans; Infant; Infant, Newborn; Male; Operative Time; Peptide Fragments - metabolism; Pilot Projects; Postoperative Complications - diagnosis; Protein Precursors - metabolism; Troponin - metabolism; Cardiopatía congénita; Congenital heart disease; Children; Niños; Biomarcadores cardiacos; Cardiac biomarkers
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/j.rec.2016.09.011

To assess the predictive value of atrial natriuretic peptide, β-type natriuretic peptide, copeptin, mid-regional pro-adrenomedullin (MR-proADM) and cardiac troponin I (cTn-I) as indicators of low cardiac output syndrome in children with congenital heart disease undergoing cardiopulmonary bypass (CPB).
After corrective surgery for congenital heart disease under CPB, 117 children (aged 10 days to 180 months) were enrolled in a prospective observational pilot study during a 2-year period. The patients were classified according to whether they developed low cardiac output syndrome. Biomarker levels were measured at 2, 12, 24, and 48 hours post-CPB. The clinical data and outcome variables were analyzed by a multiple logistic regression model.
Thirty-three (29%) patients developed low cardiac output syndrome (group 1) and the remaining 84 (71%) patients were included in group 2. cTn-I levels >14 ng/mL at 2hours after CPB (OR, 4.05; 95%CI, 1.29-12.64; P=.016) and MR-proADM levels>1.5 nmol/L at 24hours following CPB (OR, 15.54; 95%CI, 4.41-54.71; P<.001) were independent predictors of low cardiac output syndrome.
Our results suggest that cTn-I at 2hours post-CPB is, by itself, an evident independent early predictor of low cardiac output syndrome. This predictive capacity is, moreover, reinforced when cTn-I is combined with MR-proADM levels at 24hours following CPB. These 2 cardiac biomarkers would aid in therapeutic decision-making in clinical practice and would also enable clinicians to modify the type of support to be used in the pediatric intensive care unit.