Changes of Adrenodullin and C-Type Natriuretic Peptide in Children with Chronic Heart Failure

Objective To investigate the changes of plasma adrenodullin(ADM) and C-type natriuretic peptide(CNP) level in children with chronic heart failure(CHF) and its clinical implications.Methods Forty-two children with CHF were collected.The patients suffered from dilated cardiomyopathy,congenital heart defects,and other heart diseases.According to a modified scoring system described by Ross and Reithman,16 patients were classified as class Ⅱ,14 as class Ⅲ,and 12 as class Ⅳ.Plasma levels of ADM and CNP were measured by radioimmunoassay assay in these patients and 11 healthy children.Echocardiography was performed to measure left ventricular function and the ratio of E/A.Results Plasma ADM and CNP levels of CHF patients were significantly elevated as compared with those of the control subjects [(218.27±106.53) ng/L vs(74.39±53.99) ng/L,P=0;(190.27±108.38) ng/L vs(92.59±(59.46) ng/L),P0.01].A negative correlation of plasma ADM and CNP levels with LVEF(r=-0.69 P0.001;r=-0.48(P0.001));and ADM level has positive correlation with E/A,and plasma CNP level has no correlation with E/A(r=0.34 P0.01;(r=0.27) P0.05).ADM levels were elevated with the advancing severity of CHF determined by a modified scoring system described by Ross.However,the plasma CNP levels in the normal state wasn′t significantly different from those observed in class Ⅱ.Likewise,the plasma CNP level in the class Ⅲ was not significantly different from that observed in class Ⅱ.Conclusions ADM and CNP might play a compensatory and defensive roles in the pathophysiology of the pediatric CHF.ADM may be a biochemical marker for evaluation the severity of the chronic heart failure in children,but also a new prognostic indicator of this syndrome.