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N-terminal pro-brain natriuretic peptide in acute Kawasaki disease correlates with coronary artery involvement

Published online by Cambridge University Press:  29 December 2014

Philippe M. Adjagba ,
Laurent Desjardins ,
Anne Fournier ,
Linda Spigelblatt ,
Martine Montigny  and
Nagib Dahdah
Philippe M. Adjagba
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada Department of Cardiology, Hopital de la Mère et de l’Enfant-Lagune, Cotonou, Bénin
Laurent Desjardins
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada School of Medicine, McGill University, Montreal, Quebec, Canada
Anne Fournier
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
Linda Spigelblatt
Affiliation:
Department of Pediatrics, Maisonneuve Rosemont Hospital, Montréal, Canada
Martine Montigny
Affiliation:
Department of Cardiology, Cité-de-la-Santé Hospital, Laval, Quebec, Canada
Nagib Dahdah*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
*
Correspondence to: N. Dahdah, MD, FACC, FASE, FRCPC, Division of Pediatric Cardiology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175, Côte Sainte-Catherine, Montréal, QC H3T 1C5, Canada. Tel: 514 345 4931, ext 5403; Fax: 514 345 4896; E-mail: nagib.dahdah.hsj@ssss.gouv.qc.ca
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Abstract

Background

We have lately documented the importance of N-terminal pro-brain natriuretic peptide in aiding the diagnosis of Kawasaki disease.

Objectives

We sought to investigate the potential value of N-terminal pro-brain natriuretic peptide pertaining to the prediction of coronary artery dilatation (Z-score>2.5) and/or of resistance to intravenous immunoglobulin therapy. We hypothesised that increased serum N-terminal pro-brain natriuretic peptide level correlates with increased coronary artery dilatation and/or resistance to intravenous immunoglobulin.

Methods

We carried out a prospective study involving newly diagnosed patients treated with 2 g/kg intravenous immunoglobulin within 5–10 days of onset of fever. Echocardiography was performed in all patients at onset, then weekly for 3 weeks, then at month 2, and month 3. Coronary arteries were measured at each visit, and coronary artery Z-score was calculated. All the patients had N-terminal pro-brain natriuretic peptide serum level measured at onset, and the Z-score calculated.

Results

There were 109 patients enrolled at 6.58±2.82 days of fever, age 3.79±2.92 years. High N-terminal pro-brain natriuretic peptide level was associated with coronary artery dilatation at onset in 22.2 versus 5.6% for normal N-terminal pro-brain natriuretic peptide levels (odds ratio 4.8 [95% confidence interval 1.05–22.4]; p=0.031). This was predictive of cumulative coronary artery dilatation for the first 3 months (p=0.04–0.02), but not during convalescence at 2–3 months (odds ratio 1.28 [95% confidence interval 0.23–7.3]; p=non-significant). Elevated N-terminal pro-brain natriuretic peptide levels did not predict intravenous immunoglobulin resistance, 15.3 versus 13.5% (p=1).

Conclusion

Elevated N-terminal pro-brain natriuretic peptide level correlates with acute coronary artery dilatation in treated Kawasaki disease, but not with intravenous immunoglobulin resistance.

Keywords

Kawasaki diseasepredictioncoronary artery involvementN-terminal pro-brain natriuretic peptidepredictive value
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 7 , October 2015 , pp. 1311 - 1318
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Copyright
© Cambridge University Press 2014 

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