Abstract Ref Number = APCP216
THE ROLE OF NT-proBNP AND TROPONIN I IN EARLY DETECTION OF HEART FUNCTION IN PROTEIN ENERGY MALNUTRITION CHILDREN
Background : Protein Energy Malnutrition (MEP) in children is still a public health problem in many developing countries such as Indonesia. The long-term effects of MEP can cause changes in the structure and function of organs including the cardiovascular organs.Troponin I and NT-proBNP are markers that have high diagnostic values in myocardial injury due to cardiomyopathy and may be can be used in severe MEP children.
Material : A diagnostic study with cross sectional design was conducted in 60 MEP children at Zaenoel Abidin Hospital Banda Aceh from July to December 2015. Chidren aged 1 month to < 18 years were included. Congenital heart disease or acquired cardiovascular disease, kidney disease, respiratory disease, sepsis,anemia, hypotensia, hypothermia, bradycardia, electrolyte disturbances, hypoglycemia and hypoalbuminemia were excluded. Diagnostic values were evaluated in this study.
Results : There were 60 children with MEP, 39 (65%) moderate MEP and 21 (35%) severe MEP, 35 (58.3%) female and 25 (41.7%) male. The age ranged from 8 months to 186 months (15 years 6 months).The echocardiography examination, 55 (91,7%) had impaired left ventricular function (systolic or systolic and diastolic), 4 (7,2%) had only systolic disorder and 51 (85%) had impaired systolic and diastolic function. The pattern of left ventricular diastolic disorder is a restrictive pattern. The median ejection fraction was 57.5% (40- 89%) and the median of the shortening fraction was 29% (20- 58%). In ventricular diastolic dysfunction, E wave peak height was higher than normal with median 1.11 m / s (0.62 - 1.89 m / s), normal A wave peak with median 0.42 m / s (0.27 - 1.08 m / s) and a high E / A wave ratio of values with a median of 2.62 (1.49 - 3.97). Weight / left ventricular heart mass. with median 67.4 g (29.6 - 149.2) g. There were 52 children (86.7%) MEP had a small left / left ventricular mass (hypotropy). The NT-proBNP level a cut-off point of ? 100,3 ng / ml and the Troponin I level a cut-off point of ? 4.05 pg / ml. The diagnostic study showed: for NT-proBNP(CI 95%), 85.5% Sensitivity; 40.0% Specificity; 94% Positive predictive value; 20.0% Negative predictive value; 1.42 Positive probability ratio and 0.36 negative probability ratio. for Troponi I CI 95%), 90.9% Sesitivity; 40.0% Specificity; 94.3% Positive predictive value; 28.6% Negative predictive value; 1.5 Positive probability ratio; 0.2 Negative probability ratio.
Conclusions : The child with MEP had reduction in left ventricular mass (left ventricular hypothropy) and impaired of left ventricular function. The value of NT-proBNP and Troponin I were increased in child with MEP.The cut-off point NT-proBNP is ?100.3 ng/ml and the cut-off point Troponin I is ?4.55 with. The both of marker had good diagnostic value for early detection impaired Left ventricular function in child with MEP.
Keywords: MEP Mass and Fuction of Left ventricular NT-proBNP Troponin I