Cardiology in the Young



Original Article

Brain natriuretic peptide can be a useful biochemical marker for myocarditis in patients with Kawasaki disease


Takashi Kawamura a1c1 and Masakuni Wago a1
a1 Department of Pediatrics, Hiroshima City Asa Hospital, Hiroshima, Japan

Article author query
kawamura t   [PubMed][Google Scholar] 
wago m   [PubMed][Google Scholar] 

Abstract

So as to determine the value of brain natriuretic peptide in the plasma as a biochemical marker for myocarditis of Kawasaki disease, we studied 69 patients. The blood samples, electrocardiograms and cross-sectional echocardiograms were obtained before the commencement of treatment and in the convalescent phase. Results: The mean concentration of brain natriuretic peptide in the plasma was 73.2 ± 107.7 (mean ± SD) pg/ml in the acute phase, and 7.9 ± 7.5 pg/ml in the convalescent phase. We checked the electrocardiograms to find abnormal Q waves, elevation or depression of the ST segments, change in the pattern of the QRS complexes, and flattening or inversion of the T wave, all believed to be markers of myocarditis in Kawasaki disease. Those in whom the concentrations were greater than 50 pg/ml in the acute phase showed abnormal electrocardiograms more frequently than did those in whom the values were less than 50 pg/ml (21/29 vs 3/40, p < 0.0001 odds ratio 32.4). Amplitudes of the T wave in standard limb leads were measured both in the acute and convalescent phases, and the differences calculated. We regarded the sum total of these differences as representing “flattening T wave”, and we named this variable as the total suppressed T wave voltage. We examined the correlation between the variable and the levels of brain natriuretic peptide in the plasma during the acute phase, demonstrating a significant correlation (r = 0.500, p < 0.0001). We conclude, therefore, that the concentration of brain natriuretic peptide measured in the plasma can be a useful biochemical marker for the myocarditis of Kawasaki disease. When the titer is over 50 pg/ml, the patient probably has an abnormal electrocardiogram and is most likely to have myocarditis.

(Published Online August 15 2006)
(Accepted September 26 2001)


Key Words: Brain natriuretic peptide; myocarditis; Kawasaki disease.

Correspondence:
c1 Correspondence to: Takashi Kawamura MD, Department of Pediatrics, Hiroshima City Asa Hospital 2 chome 1 – 1 Kabeminami, Hiroshima city, 731-0223, Japan. Tel: 81 82 815 5211; Fax: 81 82 814 1791; E-mail: child@asa-hosp.city.hiroshima.jp