RESUMO
Objective To assess the values of growth differentiation factor-15 (GDF-15) and N-terminal probrain natriuretic peptide (NT-proBNP) for the diagnosis of children with congenital heart disease (CHD) combined with heart failure.Methods Among the children under treatment at the First Affiliated Hospital of Xinjiang Medical University from Jan.2011 to Dec.2012,206 children those suffered with CHD were selected as the case group.One hundred and five children without CHD or heart failure were selected as the control group.Improved Ross score ≥ 3 grades was taken as reference standard for heart failure.The case group was divided into non-heart failure group (0-2 grades,112 cases) and the heart failure group (3-12 grades,94 cases).The heart failure group was divided into mild heart failure group (3-6 grades,38 cases),moderate heart failure group (7-9 grades,32 cases) and severe heart failure group (10-12 grades,24 cases).Levels of plasma GDF-15 and NT-proBNP were tested.In the meanwhile,the left ventricular ejection fraction (LVEF) was tested with ultrasonic cardiogram.Linear correlation analysis was performed for evaluating levels of plasma GDF-15 and NT-proBNP against the cardiac function grading in Ross scores and the LVEF,respectively.ROC curve was made to determine critical point or threshold value of diagnosis and assess values of levels of plasma GDF-15 and NT-proBNP for diagnosis of congenital heart disease combined with heart failure.Results Comparison of age and gender differences between the case group and the control group showed no statistically significant(x2 =4.233,4.360,P ＞ 0.05).Levels of plasma LogGDF-15 and LogNT-proBNP in the heart failure group were significantly higher than those values of the non-heart failure group and the control group(F =115.2,63.2,all P ＜ 0.01).Levels of plasma GDF-15 and NT-proBNP increased with the severity of heart failure and were positively correlated with improved Ross scores (r =0.890,P ＜ 0.01) and negatively correlated with LVEF (r =-0.652,P ＜ 0.01).GDF-15 was considered in combination with NT-proBNP,the specificity(80.2％) and precision(77.9％) for diagnosis of heart failure could be enhanced when plasma GDF-15 ＞ 831.6 ng/L coexisted with NT-proBNP ＞ 759.8 ng/L.Conclusions Plasma GDF-15 and NT-proBNP can help the diagnosis of heart failure caused by CHD in children.The increase of these two factors is closely related to the severity of clinical heart failure.Combination of these two factors for test can enhance specificity and precision for diagnosis of heart failure.
