Liem David A, Cadeiras Martin, Setty Shaun P
Department of Medicine, Division of Cardiovascular Disease, University of California, Davis, CA, USA.
Department of Pediatric and Adult Congenital Cardiac Surgery, Miller Children's and Women's Hospital and Long Beach Memorial Hospital, Long Beach, CA, USA.
Cardiovasc Diagn Ther. 2023 Feb 28;13(1):83-99. doi: 10.21037/cdt-22-386. Epub 2023 Jan 9.
Heart failure (HF) in the pediatric population is a multi-factorial process with a wide spectrum of etiologies and clinical manifestations, that are distinct from the adult HF population, with congenital heart disease (CHD) as the most common cause. CHD has high morbidity/mortality with nearly 60% developing HF during the first 12 months of life. Hence, early discovery and diagnosis of CHD in neonates is pivotal. Plasma B-type natriuretic peptide (BNP) is an increasingly popular clinical marker in pediatric HF, however, in contrast to adult HF, it is not yet included in pediatric HF guidelines and there is no standardized reference cut-off value. We explore the current trends and prospects of biomarkers in pediatric HF, including CHD that can aid in diagnosis and management.
As a narrative review, we will analyze biomarkers with respect to diagnosis and monitoring in specific anatomical types of CHD in the pediatric population considering all English PubMed publications till June 2022.
We present a concise description of our own experience in applying plasma BNP as a clinical biomarker in pediatric HF and CHD (tetralogy of fallot ventricular septal defect) in the context of surgical correction, as well as untargeted metabolomics analyses. In the current age of Information Technology and large data sets we also explored new biomarker discovery using Text Mining of 33M manuscripts currently on PubMed.
(Multi) Omics studies from patient samples as well as Data Mining can be considered for the discovery of potential pediatric HF biomarkers useful in clinical care. Future research should focus on validation and defining evidence-based value limits and reference ranges for specific indications using the most up-to-date assays in parallel to commonly used studies.
儿科人群中的心力衰竭（HF）是一个多因素过程，病因和临床表现范围广泛，与成人HF人群不同，先天性心脏病（CHD）是最常见的病因。CHD的发病率/死亡率很高，近60%的患者在出生后的前12个月内会发展为HF。因此，新生儿CHD的早期发现和诊断至关重要。血浆B型利钠肽（BNP）在儿科HF中是一种越来越受欢迎的临床标志物，然而，与成人HF不同，它尚未被纳入儿科HF指南，也没有标准化的参考临界值。我们探讨了儿科HF中生物标志物的当前趋势和前景，包括有助于诊断和管理的CHD。
作为一篇叙述性综述，我们将分析截至2022年6月所有英文PubMed出版物中关于儿科人群特定解剖类型CHD的诊断和监测的生物标志物。
我们简要描述了我们自己在将血浆BNP作为儿科HF和CHD（法洛四联症、室间隔缺损）手术矫正背景下的临床生物标志物应用的经验，以及非靶向代谢组学分析。在当前的信息技术和大数据集时代，我们还利用对PubMed上目前的3300万篇手稿进行文本挖掘探索了新的生物标志物发现。
可以考虑对患者样本进行（多）组学研究以及数据挖掘，以发现对临床护理有用的潜在儿科HF生物标志物。未来的研究应侧重于验证，并使用最新检测方法与常用研究并行，为特定适应症确定基于证据的价值界限和参考范围。
