Cardiac function in pulmonary hypertension: the usefulness of biochemical markers and echo in management of CDH infants

  • Dr Maria Baptista, Pediatric Cardiology, H. S. Joćo, Porto; Life and Health Sciences Research Institute, Minho University, Portugal
  • Dr Gustavo Rocha, Neonatology Service, Hospital S. Joćo, Porto, Portugal
  • Dr Fįtima Clemente, Neonatology Service, Hospital S. Joćo, Porto, Portugal
  • Dr Luis Azevedo, Bioestatistica e Informįtica Médica, Faculdade de Medicina, Porto, Portugal
  • Dr José Areias, Pediatric Cardiology, H. S. Joćo, Porto, Portugal
  • Dr Jorge Correia-Pinto, Pediatric Surgery Dpt, H S Joćo, Porto; Life and Health Sciences Research Institute, Minho University, Portugal

    • Background: The severity of pulmonary hypertension (PH) in congenital diaphragmatic hernia (CDH) seems to be determinant of clinical outcome. The increased right ventricle (RV) afterload could interfere in heart function contributing for the poor outcome in most affected newborns. Our aim was to evaluate the clinical usefulness of biochemical and echocardiographic markers of ventricular overload in management of CDH infants.

    Methods: 28 newborns, CDH (n=18) and age-matched controls (n=10) were enrolled in a prospective study. We assessed N terminal-pro-B type natriuretic peptide (NT-proBNP) plasmatic levels, echo parameters of PH and biventricular function at 24 h after delivery as well as survival outcome.

    Results: In comparison to control group, CDH infants presented higher estimated mean pulmonary pressure and NT-proBNP. Regarding echocardiographic parameters of RV function, CDH infants presented higher RV Tei index and lower peak pulmonary velocity as well as E/A wave tricuspid ratio, suggesting impairment in RV function. Concerning left ventricle (LV), CDH infants had a significant increase in LV ejection fraction and a decreased E/A wave mitral ratio, evocative of LV function changes. We found significant correlations between NT-proBNP and estimated pulmonary mean pressure, RV Tei index and tricuspid E/A ratio. Additionally, we found that CDH infants with NT-proBNP higher than 11.500 pg/ml experienced a worse prognosis.

    Conclusions: We demonstrated that PH is associated with NT-proBNP elevation and heart function adaptation in CDH infants. We believe that echocardiographic study and early elevations in NT-proBNP levels could alert for a subset of CDH infants with worse prognosis.