BNP Levels Predict Outcome in Pediatric Heart Failure Patients: Post- hoc Analysis of the Pediatric Carvedilol Trial Running Title: BNP Predicts Pediatric Heart Failure Outcomes

Background: The ability of serum B-type natriuretic peptide levels (BNP) to predict outcomes in children with heart failure (HF) has not been well demonstrated. This study was designed to determine if BNP levels predict outcomes in patients with moderate symptomatic HF. Methods and Results: We investigated whether enrollment BNP levels for the Pediatric Carvedilol Trial were associated with baseline characteristics. Freedom from a composite endpoint of HF hospitalization, death, or transplantation at 9 months was compared using a threshold BNP level identified using receiver operating curve analysis. Median BNP level was 110 pg/ml (Interquartile range [IQR], 22.4 to 342.0 pg/ml) in 138 subjects. Median age was 3.4 years (IQR 1.1-11.0 years). Diagnoses were cardiomyopathy (60%) and congenital heart disease (40%); 73 % had a systemic left ventricle (LV). BNP levels correlated moderatel