How useful are B-type natriuretic peptide measurements for monitoring changes in patent ductus arteriosus shunt magnitude?

Abstract

Objective: Although B-type natriuretic peptide (BNP) concentrations seem to be useful for detecting the presence of patent ductus arteriosus, there is no information about their usefulness for monitoring changes in PDA shunt magnitude. Study Design: We performed a retrospective analysis of paired BNP–echocardiogram measurements (obtained from infants (24 to 32 weeks gestation) with clinical suspicion of PDA). Result: Individual BNP concentrations (n=146, from 88 infants) were significantly related to shunt magnitude at the time of measurement and had good discriminating power for detecting a moderate-or-large shunt (area under receiver-operator characteristic curves (ROC-AUC)=0.85). In total, 36 infants had serial BNP–echocardiogram pairs (n=91) measured during their hospitalization. Changes (either increases or decreases) in BNP concentrations over time had only fair discriminating power (ROC-AUC=0.76) for detecting increases or decreases, respectively, in shunt magnitude. Conclusion: The high degree of variability in the BNP measurements made them less useful for monitoring changes in magnitude.