الفهرس 
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Abstract
Pulmonary hypertension (PH) is a potential complication of CHD causing considerable morbidity and mortality. PH clearly affects RV ending finally in RV hypertrophy and failure. Being non invasive and easy, several biomarkers are recently studied for diagnosis of PH and predicting its outcome. One of these biomarkers is copeptin that is implicated in stress response. It is known that copeptin is elevated in LV overload, but may increase also in PH of different etiologies. The objectives of the present work were to evaluate the plasma levels of copeptin in children with CHD associated with PH (PAH-CHD), to correlate its levels with various clinical and echocardiographic data, and to evaluate its diagnostic and prognostic value in such patients. This study was conducted on (50) children with CHD. Patients were selected from those admitted at Pediatric Cardiology Unit, Pediatric Department, Tanta University Hospital. They were 24 males and 26 females, their ages ranged from 2 months to 19 months The patients were classified into two groups: group 1:.25 children with PAH-CHD (mPAP ≥ 25 mmHg). group 2:.25 children with CHD and no PH (mPAP < 25 mmHg). Twenty-five (25) healthy children of matched age and sex served as a control group. They were 12 males and 13 females and their ages ranged from 2 months to 17 months. All children included in the study were subjected to the following: Ι- Complete history taking and thorough clinical examination: II - Investigations: A. Plain X-ray chest and heart. B. ECG. C. Echocardiographic assessment: using Vivid 7 ultrasound machine (GE Medical System, Horten, Norway) with 7 and 4s MHz multi- frequency transducers. Doppler, two dimensional, and M mode were used for the assessment of the following: - Type of congenital heart disease. - Right ventricular systolic function: right ventricular fractional area change was measured by 2-D echocardiography. - Right ventricular diastolic function: was measured through pulsed transtricuspid Doppler in the form of tricuspid E/A ratio. D. Plasma level of copeptin : using ELISA kits. The results of the present study revealed that: • There was a significant decrease of the body weight in the patient groups compared to control group. • There was a significant increase of the heart rate and respiratory rate in the patient groups compared to control group. • Echocardiographic findings showed a statistically significant decrease of RV FAC, RV E/A ratio, and LVEF in group I compared to group II and control group. • There was a highly significant increase in plasma levels of copeptin in PAH-CHD group compared to those without PH and to control group. • There was a significant increase of plasma copeptin levels in PAH-CHD patients with increasing severity of PH. • There was a significant increase of plasma copeptin levels in PAH-CHD patients with bad prognosis as compared to those with good prognosis. • There was a significant positive correlation between plasma copeptin levels and mPAP, whereas there was a significant negative correlation between plasma copeptin level with diastolic RV function (E/A) and LV EF. • ROC curve analysis showed that the cutoff point of plasma copeptin level to differentiate cases in group I (PAH -CHD) from group II (without PH) was >18.4 with 84% sensitivity, 80% specificity, PPV of 80.8% and NPV of 83.3%. • ROC curve analysis showed that the cutoff point of plasma copeptin level to predict bad prognosis (death + Readmission) in group I was >19.2 with 90% sensitivity, 80% specificity, PPV of 94.7% and NPV of 66.7%.