ABSTRACT
The goal of this study is to delineate the role of adrenomedullin [ADM] and brain natriuretic peptide in the pathophysiology of chronic heart failure [CHF] and the potential use of their circulating levels for diagnosis and treatment of heart failure. Fifty children [19 males and 31 females] with chronic congestive heart failure [CHF] were enrolled in this study. Plasma ADM and BNP levels were assayed by radioimmunoassay and ELISA respectively. Enrolled children were classified into four classes according to New York association functional class [NYHA]. Their age ranged between one year to fifteen years. Twenty-one children [8 males and 13 females] with age ranging from 3-13 years served as control group. The results showed that the plasma concentrations of adrenomedullin [ADM] in pg/ml increased progressively with advancing class of heart failure by NYHA; 3.45 +/- 0.59 for class I, 5.32 +/- 0.95 for class II, 7.29 +/- 1.18 for class III and 14.65 +/- 2.06 for class IV, that were significantly higher than in controls [1.97 +/- 0.46, P<0.001]. Also, plasma BNP concentrations in ng/l were 42.56 +/- 4.14, 129.4 +/- 18.85, 569.05 +/- 37.76 and 1039 +/- 359.57 respectively in children of NYHA class I, II, III and IV, that were higher than in controls [9.21 +/- 1.433, P<0.001]. there was a significant positive correlation, between ADM and BNP in relation to severity of heart failure. ADM and BNP concentrations were significantly reduced after treatment. Adrenomedullin and natriuetic peptide appears to participate actively in the pathogenesis and perpetuation of chronic heart failure in children. This fact might open a new pathogenesis and perpetuation of chronic heart failure in children. This fact might open a new therapeutic channel for children with heart failure to prevent progression to chronicity and to those with already chronic heart failure through uses of ADM and BNP agonist specific for their receptors
Subject(s)
Humans , Male , Female , Chronic Disease , Natriuretic Peptide, Brain , Disease Progression , Enzyme-Linked Immunosorbent Assay , RadioimmunoassayABSTRACT
This study was done to delineate the role of endothelin-1 [ET-1] and von willebrand factor [vWF] in the pathophysiology of pulmonary hypertension [PHT] secondary to congenital heart disease. Forty-three children [29 males, 14 females] with cyanotic and acyanotic congenital heart diseases were enrolled in this study. Their age ranged between 4 months 5.10 year. Plasma ET-1 levels and vWF:Ag activity were assayed by enzyme linked immunosorbent assay. Enrolled children were divided into three groups according to pulmonary artery pressure [PAP]. Group 1 with normal PAP [/= 50mmHg] [n=14]. Twelve perfectly matched healthy children were enrolled as a control group. The results of the present study showed that plasma ET-1 levels in group I were significantly higher than that in control group [P<0.001], on the other hand no significant differences were noted in vWF: Ag% in both groups. Plasma endothelin-1 and vWF:Ag were significantly elevatd in all groups with PHT Vs controls [P<0.001 and P<0.001]. Plasma endothelin-1 and vWF: Ag% were significantly elevated in group III Vs both group II and I [P<0.001]. plasma endothelin-1 and vWF:Ag% were significantly elevated in group II Vs group I [P<0.001 and P<0.001]. Plasma ET-1 levels and vWF:Ag% positively correlated with pulmonary artery pressure in group II and III [P<0.001 and P0.001]. Elevated ET-1 and vWF may contribute directly to development of pulmonary hypertension in children with congenital heart diseases. ET-1 and vWF estimation could be used as non-invasive early markers of pulmonary hypertension in such children, particularly in post-operative evaluation. Our data are in keeping with evidence of significant coagulation abnormalities in pulmonary hypertension and the need for chronic anticoagulant therapy may increase survival in children with pH. These facts opened the door for exploring therapeutic anti-ET-1 and anti- vWF agents in the treatment of pulmonary hypertension in children