Simple Test May Help Identify Serious Heart Disease in Children By Kevin Self Reviewed by Elizabeth Klodas, MD, FACC  and   Heart disease is the leading cause of death worldwide. The ability to detect symptoms early and provide the appropriate treatment remains one of the best ways to improve the outcomes of individuals with serious heart disease. But what happens when patients are not able to communicate and describe their symptoms? What happens when the patient is a small child?

Children remain one of the most difficult populations to diagnose and treat for heart disease. For many reasons — including lack of communication and relatively little health history — there are few methods available to easily detect serious heart disease in children. A new study, however, might offer front-line physicians just the test they need to help in this effort.

B-type natriuretic peptide (BNP) is a hormone that is released by the heart when it is being stretched or is under stress. BNP levels are assessed using a blood test.  The amount of blood needed for the assay is very small and can be obtained from a finger stick.  Measuring BNP levels in adult patients is well accepted, and has proven an effective means of detecting problems with heart function. Knowing this, a group of researchers wanted to see if the BNP test might be useful for children as well.

The study, known as The Better Not Pout Children! Study, took 100 children without known heart disease, ranging from newborns to 19 years old, and subdivided them into two groups — 0–7 days old and 8 days–19 years old. Each child was examined by their physician after exhibiting symptoms that could have been explained by a serious heart problem. The BNP test was administered and the results recorded.

More than 90% Accurate

The field study produced convincing results that the BNP test would be a great addition to the diagnostic tools available to physicians. For children younger than 7 days old, a BNP measurement of 170 or greater was accurate in identifying the presence of significant heart disease 91% of the time. For older children, a BNP of 41 or greater predicted serious heart disease 77% of the time.

“This study validates that a single plasma BNP measurement can be extremely useful in diagnosing a variety of significant heart diseases,” says Dr. Yuk M. Law at Children’s Hospital and Regional Medical Center, University of Washington, and lead author of the study.

 “It is critical to diagnose neonatal and pediatric patients as quickly as possible because of the lack of a clear history and the gravity of the situation is not always measured properly,” says Dr. Thenral Socrates from the Department of Internal Medicine, University Hospital Basel in Switzerland, and lead author of an editorial accompanying The Better Not Pout Children! Study article. “BNP may have a great future for children as a possible tool in adding details to the whole story.”
 
It is important, however, to emphasize that BNP is not a standalone test. The physician’s judgment and thorough evaluation of the patient is still required.

“There is not enough attention paid to children,” says Law, describing one of the reasons for the study. “We wanted to help serve an under-served segment of society.”

The survey results are published in the October 6, 2009 issue of the Journal of the American College of Cardiology.

Sources: 

Law YM et al. Accuracy of Plasma B-Type Natriuretic Peptide to Diagnose Significant Cardiovascular Disease in Children. The Better Not Pout Children! Study. Journal of the American College of Cardiology, 2009.

Socrates T et al. B-type Natriuretic Peptide in Children, Step by Step…, Journal of the American College of Cardiology, 2009.

Dr. Yuk M. Law, Children’s Hospital and Regional Medical Center, University of Washington, Seattle, WA.

Dr. Thenral Socrates, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.