Elevation of atrial natriuretic peptide prohormone. Hemodynamic backgroundof the elevation of N-terminal natriuretic peptide prohormone in children with congenital heart disease

We postulated previously that variables related to pulmonary flow are indep endent predictors of levels of atrial natriuretic peptide in children with congenital heart disease. The aim of this study was to test this hypothesis in relation to other hemodynamic and clinical variables. During catheterization we measured the levels of plasma N-terminal atrial n atriuretic peptide prohormone in the plasma of 68 children with congenital heart disease. All had undergone complete clinical, echocardiographic and i nvasive hemodynamic investigations. The influence on the prohormone was ana lyzed for 10 different variables in a multiple linear regression model. The variability could be explained in large parts (adjusted R-2 = 77.2%) by va riations in atrial pressures or sizes, together with the degree of excessiv e pulmonary blood flow and signs of heart failure. A value for atrial natriuretic peptide prohormone above 800 pmol/l predicte d hemodynamic imbalance (defined as elevated pressures in left or right atr ium or the pulmonary arteries, and/or Q(p)/Q(s) > 1.5) with a specificity o f 94%, a sensitivity of 73%, a positive likelihood ratio of 12.2, and a neg ative likelihood ratio of 0.29. In conclusion, variables related to pulmonary blood flow are influential de terminants of the levels of atrial natriureic peptide in children with cong enital heart disease. Atrial pressures, and symptoms of heart failure are a lso of major importance.