N-terminal pro-brain natriuretic peptide concentration in pediatric patients with chronic rheumatic valve disease

B-type natriuretic peptide (BNP) is an endogenous peptide hormone mainly secreted by the cardiac ventricles in response to increased wall stress. It is synthesized as preprohormone, consisting of 108 amino acids; processing releases the biologically active 32-amino acid peptide and an amino-termina fragment (NT-proBNP).As NT-proBNP is more stable structure compared with BNP in whole blood for more than 24 hours at 20 ° C, is not significantly influenced by exercise, and position these factors confer its potential as an additional tool in the assessment of ventricular systolic dysfunction.The aim of the present study is to determine the concentrations of NT proBNP in chronic RHD patients to correlate the level of NT-pro BNP with their clinical, and echocardiography data The study included (30) cases divided into Twenty Patients with RHD without congestive heart failure and ten patients with RHD in congestive heart failure. Both group were compared with control group consisting of 10 children apparently healthy, age and sex matched children.All patients were subjected to :1. Full history taking and a complete clinical examination2. Complete Blood Cell Count (CBC) 3. Chest x ray 4. E.C.G 5. Echocardiography;- was performed by M-mode, two dimensional images and recording Left ventricular function fractional shortening and ejection fraction. 6. Level N-terminal pro-Brain natriuretic peptide. BNP is a useful biomarker reflecting disease severity, increasing with progression of disease and reflecting subclinical myocardial dysfunction. It is the ideal biomarker allowing the identification of a high-risk individual with severe disease before the development of symptoms who could undergo valve surgery without increased perioperative mortality. BNP is a noninvasive marker for early cardiac decompensation (Steadman et al., 2010 There are a statistically non-significant difference between the groups regarding age and sex. Hemoglobin level show significant difference between all groups.RBCs count there are significant difference between all groups except between RHD without heart failure and control group, there are no significant difference between all groups in total leukocytes and platelets counts. In group RHD without heart failure 16cases (80%) with left ventricular enlargement against 4cases (20%) with no left ventricular enlargement .and only 2cases show right ventricular enlargement. In group RHD with heart failure 9 cases (90%) have left ventricular enlargement and 5 (50%) with biventricular enlargement so about 25 cases (85%) in both groups with left ventricular enlargement and 7 cases (30%) with biventricular enlargement. Our study shows that there was signifiocant incrase in BNP levels in patients with RHD with or without HF. Also, it shows that there was positive correlation between levels of BNP and LAD, as well severity of MR and negative correlation between levels of BNP and LVEF. Conclusion BNP in patients with chronic RHD is considered to be a potential marker for the severity of the disease as well as we consider more further studies over large scale of patients to determine whether the BNP can provide a simple method for monitoring asymptomatic RHD patients and to delineate whether the serial measurements of this peptide are helpful for deciding the optimal time for surgical intervention.