Paediatric heart failure-understanding the pathophysiology and the current role of cardiac biomarkers in clinical practice

Paediatric heart failure (HF) is defined by the International Society for Heart & Lung Transplantation (ISHLT) as “a clinical and pathophysiologic syndrome that results from ventricular dysfunction, volume, or pressure overload, alone or in combination” (1). Kantor et al describe it as “as the failure of the heart to supply blood to either systemic or pulmonary circulation at an appropriate rate of flow, or to receive venous return at an appropriate filling pressure, resulting in adverse effects on the heart, the circulation, and the patient” (2).
In high income countries, paediatric heart failure is primarily caused by congenital heart disease or cardiomyopathy. In low- and middle-income countries, rheumatic heart disease and infective endocarditis remain the most common causes of paediatric heart failure. It is important to understand the background pathophysiology to paediatric heart failure before considering the role of various plasma biomarkers in this disease process. In clinical medicine, we routinely measure various plasma components which have an active role in the body to diagnose and monitor a patient’s health. In adult patients, cardiac biomarkers are recommended in the diagnosis of heart failure and to aid clinical management. However, in paediatric patients their use has remained mostly scientific as a result of differences in the underlying mechanism of cardiac dysfunction and influence of age affecting the assay levels.
This review provides a comprehensive overview of paediatric heart failure caused by congenital heart disease and cardiomyopathy and considers the available evidence for cardiac biomarkers in this complex, multifactorial condition.
A literature review was completed using MEDLINE ALL, EMBASE and PubMed on 10th November 2022. Search terms included biomarkers, heart failure, heart defects, congenital heart disease, Fontan circulation, single ventricle circulation, cardiomyopathy, and child.