Correlation of heart failure severity and N-terminal pro-brain natriuretic peptide level in children

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Yasmien Mahrani
Ria Nova
Masagus Irsan Saleh
Kemas Yakub Rahadianto


Background  Heart failure affects morbidity and mortality in children with heart disease. There is no single, specific test to diagnose heart failure. The modified Ross Reithmann scoring system has been used to classify heart failure severity, but it is limited due to its subjectivity. The N-terminal pro-brain natriuretic peptide (NT-proBNP) is secreted by the ventricles during heart failure. It has been suggested as a possible marker for diagnosing heart failure.

Objective To investigate the correlation between heart failure severity and plasma NT-proBNP concentration in children aged one month to 14 years.

Methods A cross-sectional study was performed in the Pediatrics Department of Mohammad Hoesin Hospital from July to September 2015 on children with congestive heart failure, aged one month to 14 years. Heart failure severity was assesed using the modified Ross Reithmann scoring system. Plasma NT-proBNP measurements were done in all subjects. Statistical analysis was done by Spearman’s test.

Results  Subjects’ median plasma NT-proBNP concentration was 1,703 pg/mL (range 310-9,000 pg/mL). The NT-proBNP level and severity of heart failure had a significant, positive correlation (r=0.87; P<0.001). The NT-proBNP minimum levels in subjects with mild, moderate and severe heart failure were 310 pg/mL, 1,251 pg/mL, and 2,610 pg/mL, respectively.

Conclusion Plasma NT-proBNP level has a significant, positive correlation with the severity of heart failure in children. As such, NT-proBNP level may be useful as a biochemical marker for the diagnosis and grading of the severity of heart failure in children.

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How to Cite
Mahrani Y, Nova R, Saleh M, Rahadianto K. Correlation of heart failure severity and N-terminal pro-brain natriuretic peptide level in children. PI [Internet]. 16Jan.2017 [cited 17Feb.2020];56(6):315-. Available from:
Received 2016-09-04
Accepted 2016-12-14
Published 2017-01-16


1. Beggs S, Thompson A, Nash R, Tompson A, Peterson G, et al. Cardiac failure in children. 17th expert committee on the selection and use of essential medicine. Geneva:WHO 2009. p.1-31.
2. Park MY. Pediatric cardiology for practitioners. 5th ed. Philadelphia: Mosby Elsevier; 2008. p. 461-73.
3. Ross RD. The Ross classification for heart failure in children after 25 years: a review and an age stratified revision. Pediatr Cardiol. 2012;33:1295-300.
4. Kantor PF, Lougheed J, Dancea A, McGillion M, Barbosa N, Chan C, et al. Presentation, diagnosis and medical management of heart failure in children: Canadian Cardiovascular Society guidelines. Can J Cardiol. 2013;29:1535-52.
5. Baghdady Y, Kamel Y, Elwan A, Tohamy K, Hussein H. N-Terminal pro brain natriuretic peptide in decompensated ventricular septal defect. Heart Mirror J. 2008;2:36-41.
6. Martinez-Rumayor A, Richards AM, Burnett JC, Januzzi JL. Biology of natriuretic peptides. Am J Cardiol. 2008;101:3-8.
7. Levin ER, Gardner DG, Samson WK. Natriuretic peptides. N Engl J Med. 1998;339:321-8.
8. Collinson PO. Natriuretic peptides – a review. Eur Cardiol. 2005;1:66-9.
9. Doust J, Lehman R, Glasziou P. The role of BNP testing in heart failure. Am Fam Physician. 2006;74:1893-8.
10. Elsharawy S, Hassan B, Morsy S, Khalifa N. Diagnostic value of N-Terminal pro-brain natriuretic peptide levels in pediatric patients with ventricular septal defect. Egyptian Heart J. 2012;64:241-6.
11. Renardi R. Hubungan nilai N-terminal pro-brain natriuretic peptide dengan keparahan penderita gagal jantung [master’s thesis]. [Medan (North Sumatera)]: Univercity of Sumatera Utara; 2009.
12. Immanuel S, Legoh G, Makmun L. Kadar amino-terminal probrain-type natriuretic peptide pada penderita gagal jantung. Majalah Kedokteran Indonesia. 2009;59:403-411.
13. Roche cardiac pro BNP+ [brochure]. 2013.
14. Sugimoto M, Manabe H, Nakau K, Furuya A, Okushima K, Fujiyasu H, et al. The role of N-terminal pro-B-type natriuretic peptide in the diagnosis of congestive heart failure in children. Circ J. 2010;74:998-1005.
15. Wu YR, Chen SB, Huang MR, Zhang YQ, Sun K, Chen S. N-terminal pro-brain natriuretic peptide in the diagnosis of congestive heart failure in pediatric patients with ventricular septal defect. World J Pediatr. 2006;2:40-4.
16. Skiendzelewski J, Werner B. Usefulness of NT-proBNP in evaluation of the stage of heart failure in infants with ventricular septal defect. University of Warsaw. Abstract P-115.
17. Sarangnga C. Korelasi negatif fraksi ejeksi ventrikel kiri dengan kadar N-Terminal pro brain natriuretic peptide pada anak dengan gagal jantung [thesis]. Bali; Udayana University. 2014.
18. Law YM, Hoyer AW, Reller MD, Silberbach M. Accuracy of plasma B-type natriuretic peptide to diagnose significant cardiovascular disease in children: the Better Not Pout Children! Study. J Am Coll Cardiol. 2009;54:1467-75.
19. Zoair AM, Mawlana WH, El-Bendary AS, Nada EA. Serum levels of amino terminal of probrain natriuretic peptide (NT-pro BNP) as a diagnostic and prognostic biomarker in children with dilated cardiomyopathy. Tanta Med J. 2014;42:53-7.
20. Kotby AA, El-Shahed GS, Elmasry OA, El-Hadidi IS, El Shafey RN. N-Terminal proBNP levels and tissue doppler echocardiography in acute rheumatic carditis. ISRN Pediatr. 2013;970394.
21. Moses E, Mokhtar S, Hamzah A, Abdullah B, Yusoff N. Usefulness of N-terminal pro B type natriuretic peptide as a screening tool for identifying pediatric patients with congenital heart disease. Lab Med. 2011;42:75-80.