Biomarker and shear stress in secondary pediatric pulmonary hypertension

Background/aim: Endothelial dysfunction, tissue damage, inflammation, and microthrombosis are involved in the pathogenesis of pulmonary hypertension (PH), which may be present as a complication of congenital heart diseases. This study aims to identify how indicators of endothelial dysfunction (shear stress), tissue damage (brain natriuretic peptide and troponin T), inflammation (C-reactive protein (CRP)), and microthrombosis (D-dimer and von Willebrand factor) are altered in children with congenital left-to-right shunting. Materials and methods: This is a review of 25 children who developed PH due to congenital left-to-right shunting, 40 children who underwent corrective surgery for congenital left-to-right shunting, and 40 healthy children.Results: Serum brain natriuretic peptide (BNP), CRP, and CA-125 levels were significantly increased and shear stress was significantly decreased in children with PH (P = 0.001, P = 0.044, P = 0.012, and P = 0.011). A BNP level of >225 pg/mL had a sensitivity of 95.3% and specificity of 92.4%, whereas a CRP level of >2.2 IU/L had a sensitivity and specificity of 87.5%, and a CA-125 level of >35 IU/mL had a sensitivity of 92.2% and a specificity of 90.4% for PH. Shear stress of <2.5 dyn/cm2 had a sensitivity of 84.8% and specificity of 92.9%.Conclusions: A combination of BNP, CRP, CA-125, and shear stress might be used to predict the development of PH during follow-up of children with congenital left-to-right shunting.