الفهرس 
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Abstract
Heart failure (HF) is defined as failure of the heart to supply the blood required for the metabolic demands of the body. It has a high morbidity and mortality in children.
So, it is very important to have simple early biomarker that can help in the diagnosis and prognosis of adverse outcome in order to change treatment strategy. Recently a number of novel HF biomarkers have evolved and help in assessing the severity of HF and predicting the course of the disease.The mechanism for the release of these markers seems to be variable from myocyte injury, ventricular remodeling and reduced coronary reserve.
cMyBP-C has been reported in many studies as a specific early diagnostic biomarker of myocardial infarction in adult through proteolysis, dephosphorylation and subsequent release into circulation. However, its clinical value in pediatric HF is not investigated yet.
Aim of the work:
To study the value of measurement of plasma levels of cardiac myosin binding protein C as a novel biomarker in the diagnosis and prognosis of heart failure in pediatric patients.
Subjects and methods:
This study is a case control hospital study.
This study included 2 groups:
Patient group: includes 35 patients with heart failure in pediatric age, they were 22 males and 13 females. The age of them ranged from 3 days to 3 years.
Summary and Conclusion
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Control group: includes 30 apparently healthy chidren of similar age and sex for comparison.
Children included in the study were subjected to:
- Full history taking.
- Complete clinical assessment.
- Full investigations: including chest x-ray and echocardiography for the patients, laboratory workups for all children in the study (blood samples were taken for ESR, CRP, HGB and serum cardiac myosin binding protein-c).
The results: of the present study showed:
As regard the demographic data: there was no statistically significant difference as regard age, sex between the patient and the control groups. On the other hand, there was significant decrease in body weight, height, and BMI of the patient group in relation to the control.
As regard the clinical data: there was significant high percentage of the patients with tachypnea, tachycardia, hepatomegally and murmur.
As regard x-ray findings in the patient group at admission: the cariothoracic ratio was > 60% in 65.7% of the patients.
As regard echocardiographic findings in the patient group at admission: ejection fraction was < 50% in 91.4% of the patients.
As regard the laboratory data of the studied groups:
- ESR: there was no significant difference between the patient and the control groups.
Summary and Conclusion
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- HGB: there was significant decrease in the patient group in relation to the control.
- CRP: there was significant increase in the patient group in relation to the control.
- Cardiac myosin binding protein-c: there was significant increase in the patient group at admission in relation to the control.there was significant decrease of it after treatment.there was no significant difference of its plasma level in the patients after treatment and the control. There was negative correlation between its plasma level in the patients at admission and their ejection fraction. There was negative correlation between its plasma level in the patients at admission and their fraction shortening. Follow up for the patients after treatment showed that in the died patients there was no significant decrease in its level after treament, while in the recovered patients there was significant decrease. We suggested that its optimal cutoff point for diagnosis of heart failure was 70 ng/ml with sensitivity 69% and specifity 83%.