Advertisement

Relationship Between Serum Brain-Type Natriuretic Peptide and Biomarkers of Growth in Infants With Shunt-Dependent Single Cardiac Ventricle

      For infants with shunt-dependent or ductal-dependent single ventricle heart disease, poor growth is common and associated with morbidity and impaired neurodevelopmental outcomes. Although attention has focused on nutrition to promote weight gain, little is known about the relation between heart failure and growth factors. A prospective observational pilot study was performed to assess the relation between heart failure, assessed by brain natriuretic peptide (BNP), and growth factors (insulin-like growth factor 1 [IGF-1] and insulin-like growth factor-binding protein 3) at 3 visits: (1) before discharge from neonatal intervention with the establishment of stable pulmonary blood flow, (2) immediately before superior cavopulmonary connection, and (3) before discharge after superior cavopulmonary connection operation. The relation between BNP and growth factors was analyzed using Spearman pairwise correlations at each visit and modeled over time with a linear mixed-effects model. Correlations were considered worthy of further exploration using a p <0.10, given the exploratory nature of the study. The study included 38 infants (66% male, 68% hypoplastic left heart syndrome). Median BNP was elevated at visit 1 and decreased over time (287 pg/dl [interquartile range 147 to 794], 85 pg/dl [52 to 183], and 90 pg/dl [70 to 138]). Median IGF-1 Z score was <0 at each visit but increased over time (−0.9 [interquartile range −1.1 to 0.1], −0.7 [−1.2 to 0.1], and −0.5 [−1.2 to 0]). Inverse correlations were found between BNP and IGF-1 at visit 1 (r = −0.40, p = 0.097), BNP and IGF-1 and insulin-like growth factor-binding protein 3 at visit 2 (r = −0.33, p = 0.080 and r = −0.33, p = 0.085, respectively) and BNP and IGF-1 Z score at visit 3 (r = −0.42, p = 0.049). Significant relations were likewise found between the change in BNP and the change in IGF-1 between visits 1 and 3 (p = 0.046) and between visits 2 and 3 (p = 0.048). In conclusion, this pilot study demonstrates an inverse correlation between BNP and growth factors, suggesting that the heart failure state associated with this physiology may play a mechanistic role in impaired growth.

      Abbreviations:

      BNP (Brain natriuretic peptide), IGF-1 (Insulin-like growth factor 1), SD-SVHD (Shunt-dependent single ventricle heart disease), SVHD (Single ventricle heart diseease)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ravishankar C
        • Zak V
        • Williams IA
        • Bellinger DC
        • Gaynor JW
        • Ghanayem NS
        • Krawczeski CD
        • Licht DJ
        • Mahony L
        • Newburger JW
        • Pemberton VL
        • Williams RV
        • Sananes R
        • Cook AL
        • Atz T
        • Khaikin S
        • Hsu DT
        • Pediatric Heart Network Investigators
        Association of impaired linear growth and worse neurodevelopmental outcome in infants with single ventricle physiology: a report from the pediatric heart network infant single ventricle trial.
        J Pediatr. 2013; 162 (e2): 250-256
        • Butts RJ
        • Zak V
        • Hsu D
        • Cnota J
        • Colan SD
        • Hehir D
        • Kantor P
        • Levine JC
        • Margossian R
        • Richmond M
        • Szwast A
        • Williams D
        • Williams R
        • Atz AM.
        Factors associated with serum B-type natriuretic peptide in infants with single ventricles.
        Pediatr Cardiol. 2014; 35: 879-887
        • Evans CF
        • Sorkin JD
        • Abraham DS
        • Wehman B
        • Kaushal S
        • Rosenthal GL.
        Interstage weight gain is associated with survival after first-stage single-ventricle palliation.
        Ann Thorac Surg. 2017; 104: 674-680
        • Miller TA
        • Zak V
        • Shrader P
        • Ravishankar C
        • Pemberton VL
        • Newburger JW
        • Shillingford AJ
        • Dagincourt N
        • Cnota JF
        • Lambert LM
        • Sananes R
        • Richmond ME
        • Hsu DT
        • Miller SG
        • Zyblewski SC
        • Williams RV
        Pediatric Heart Network Investigators. Growth asymmetry, head circumference, and neurodevelopmental outcomes in infants with single ventricles.
        J Pediatr. 2016; 168 (e1): 220-225
        • Medoff-Cooper B
        • Irving SY
        • Hanlon AL
        • Golfenshtein N
        • Radcliffe J
        • Stallings VA
        • Marino BS
        • Ravishankar C.
        The association among feeding mode, growth, and developmental outcomes in infants with complex congenital heart disease at 6 and 12 months of age.
        J Pediatr. 2016; 169 (e1): 154-159
        • Goldberg CS
        • Lu M
        • Sleeper LA
        • Mahle WT
        • Gaynor JW
        • Williams IA
        • Mussatto KA
        • Ohye RG
        • Graham EM
        • Frank DU
        • Jacobs JP
        • Krawczeski C
        • Lambert L
        • Lewis A
        • Pemberton VL
        • Sananes R
        • Sood E
        • Wechsler SB
        • Bellinger DC
        • Newburger JW
        Pediatric Heart Network Investigators. Factors associated with neurodevelopment for children with single ventricle lesions.
        J Pediatr. 2014; 165 (e8): 490-496
        • Hehir DA
        • Rudd N
        • Slicker J
        • Mussatto KA
        • Simpson P
        • Li SH
        • Frommelt MA
        • Tweddell JS
        • Ghanayem NS.
        Normal interstage growth after the norwood operation associated with interstage home monitoring.
        Pediatr Cardiol. 2012; 33: 1315-1322
        • Oster ME
        • Ehrlich A
        • King E
        • Petit CJ
        • Clabby M
        • Smith S
        • Glanville M
        • Anderson J
        • Darbie L
        • Beekman RH
        Association of interstage home monitoring with mortality, readmissions, and weight gain: a multicenter study from the national pediatric cardiology quality improvement collaborative.
        Circulation. 2015; 132: 502-508
        • Petit CJ
        • Fraser CD
        • Mattamal R
        • Slesnick TC
        • Cephus CE
        • Ocampo EC.
        The impact of a dedicated single-ventricle home-monitoring program on interstage somatic growth, interstage attrition, and 1-year survival.
        J Thorac Cardiovasc Surg. 2011; 142: 1358-1366
        • Butto A
        • Mercer-Rosa L
        • Teng C
        • Daymont C
        • Edelson J
        • Faerber J
        • Mejia E
        • Ravishankar C
        • Cohen MS.
        Longitudinal growth in patients with single ventricle cardiac disease receiving tube-assisted feeds.
        Congenit Heart Dis. 2019; 14: 1058-1065
        • Avitabile CM
        • Leonard MB
        • Brodsky JL
        • Whitehead KK
        • Ravishankar C
        • Cohen MS
        • Gaynor JW
        • Rychik J
        • Goldberg DJ.
        Usefulness of insulin like growth factor 1 as a marker of heart failure in children and young adults after the Fontan palliation procedure.
        Am J Cardiol. 2015; 115: 816-820
        • Varma Shrivastav S
        • Bhardwaj A
        • Pathak KA
        • Shrivastav A
        Insulin-like growth factor binding protein-3 (IGFBP-3): unraveling the role in mediating IGF-independent effects Within the cell.
        Front Cell Dev Biol. 2020; 8: 286
        • de Jong M
        • Cranendonk A
        • Twisk JW
        • van Weissenbruch MM.
        IGF-I and relation to growth in infancy and early childhood in very-low-birth-weight infants and term born infants.
        PLoS One. 2017; 12e0171650
        • Upners EN
        • Ljubicic ML
        • Busch AS
        • Fischer MB
        • Almstrup K
        • Petersen JH
        • Jensen RB
        • Hagen CP
        • Juul A.
        Dynamic changes in serum IGF-I and growth during infancy: associations to body fat, target height and PAPPA2 genotype.
        J Clin Endocrinol Metab. 2022; 107: 219-229
        • Corkins MR
        • Gohil AD
        • Fitzgerald JF.
        The insulin-like growth factor axis in children with inflammatory bowel disease.
        J Pediatr Gastroenterol Nutr. 2003; 36: 228-234
        • Silverstein DM.
        Growth and nutrition in pediatric chronic kidney disease.
        Front Pediatr. 2018; 6: 205
        • Watanabe S
        • Tamura T
        • Ono K
        • Horiuchi H
        • Kimura T
        • Kita T
        • Furukawa Y.
        Insulin-like growth factor axis (insulin-like growth factor-I/insulin-like growth factor-binding protein-3) as a prognostic predictor of heart failure: association with adiponectin.
        Eur J Heart Fail. 2010; 12: 1214-1222
        • Surmeli-Onay O
        • Cindik N
        • Kinik ST
        • Ozkan S
        • Bayraktar N
        • Tokel K.
        The effect of corrective surgery on serum IGF-1, IGFBP-3 levels and growth in children with congenital heart disease.
        J Pediatr Endocrinol Metab. 2011; 24: 483-487
        • Soliman AT
        • Elawwa A
        • Khella A
        • Saeed S
        • Yassin H.
        Linear growth in relation to the circulating concentration of insulin-like growth factor-I in young children with acyanotic congenital heart disease with left to right shunts before versus after surgical intervention.
        Indian J Endocrinol Metab. 2012; 16: 791-795
        • Chung HT
        • Chang YS
        • Liao SL
        • Lai SH.
        The effects of corrective surgery on endothelial biomarkers and anthropometric data in children with congenital heart disease.
        J Int Med Res. 2017; 45: 493-503
        • Oster ME
        • Kelleman M
        • McCracken C
        • Ohye RG
        • Mahle WT.
        Association of digoxin with interstage mortality: results from the pediatric heart network single ventricle reconstruction trial public use dataset.
        J Am Heart Assoc. 2016; 5e002566
        • Brown DW
        • Mangeot C
        • Anderson JB
        • Peterson LE
        • King EC
        • Lihn SL
        • Neish SR
        • Fleishman C
        • Phelps C
        • Hanke S
        • Beekman RH
        • Lannon CM
        • National Pediatric Cardiology Quality Improvement Collaborative
        Digoxin use is associated with reduced interstage mortality in patients with no history of arrhythmia after stage I palliation for single ventricle heart disease.
        J Am Heart Assoc. 2016; 5e002376