Background and aims In infants with congenital diaphragmatic hernia (CDH) plasma peptides which mediate, or are produced in response to pulmonary hypertension (PH) and cardiac dysfunction may be useful clinical biomarkers of disease severity. This study investigated correlation between candidate biomarkers and existing measures of oxygenation, PH, and cardiac function in CDH.
Methods Prospective observational study. Plasma samples were obtained for measurement of BNP, NTpro-BNP, VEGF-A, PLGF, and Tropinin1. Concomitant echocardiographic measures of pulmonary artery pressure (derived from TR jet velocity [PAPest]; and PDA flow ratio [PDAR:L]) and cardiac function (Tissue Doppler Imaging of systolic [S’] and diastolic [E’] velocities and tricuspid valve diastolic flow ratio [TVE:A]) were obtained. Oxygenation index was calculated OI.
Results 480 biomarker assays were performed in 80 samples from ten infants. OI correlated positively with BNP, NTproBNP, and VEGF-A, and negatively with PLGF (Table 1). PH measures correlated negatively with PLGF and positively with NTproBNP and Troponin1. Measures of diastolic function correlated negatively with Troponin1 and VEGF-A, and positively with PLGF.
Conclusions 1) Plasma biomarker analysis is feasible in infants with PH in CDH.
2) Worsening disease status (impaired oxygenation, PH, diastolic dysfunction) was associated with elevated BNP, NTproBNP, Troponin1 and VEGF-A, and reduced PLGF.
3) The utility of these peptides as disease biomarkers, prognostic indicators, and their role in disease pathogenesis merits further investigation.