Abstract
BackgroundMyocardial dysfunction occurs in a variety of fetal disorders. Findings from adult cardiology, where n-terminal pro-B-type natriuretic peptide (nt-proBNP) is an established biomarker of left ventricular dysfunction have been extended to fetal life. Since fetal blood sampling is technically challenging we investigated amniotic fluid nt-proBNP for its suitability to diagnose fetal myocardial dysfunction.MethodsUltrasound, Doppler examination and echocardiography was applied to classify cases and controls. Amniotic fluid nt-proBNP to amniotic fluid total protein ratio was calculated and compared to the gestational age-dependent reference intervals. In a subset of cases, fetal and maternal plasma nt-proBNP levels were determined.ResultsSpecimen from 391 fetuses could be analyzed (171 cases, 220 controls). There was a high correlation between amniotic fluid and fetal blood nt-proBNP levels (r = 0.441 for cases; r = 0.515 for controls), whereas no correlation could be detected between maternal and fetal (blood and amniotic fluid) nt-proBNP concentrations. Specificity and positive likelihood ratio of amniotic fluid nt-proBNP to amniotic fluid total protein ratio were high (0.97 and 4.3, respectively).ConclusionAmniotic fluid nt-proBNP measurement allows diagnostic confirmation of fetal myocardial dysfunction. It may serve as a useful adjunct in addition and correlation to existing tests of myocardial function, particularly in the context of invasive fetal therapy, where access to the amniotic cavity is part of the procedure.
Highlights
Myocardial dysfunction accompanies a variety of fetal conditions
There was a high correlation between amniotic fluid and fetal blood nt-proBNP levels (r = 0.441 for cases; r = 0.515 for controls), whereas no correlation could be detected between maternal and fetal nt-proBNP concentrations
The aim of our present study was to examine the role of amniotic fluid (AF)-nt-proBNP as a biomarker in pregnancies complicated by fetal conditions associated with myocardial load
Summary
Myocardial dysfunction accompanies a variety of fetal conditions. These include structural cardiac defects, primary myocardial diseases and cardiomyopathies. Methods available for the assessment of fetal myocardial function include echocardiography, Doppler sonography of the fetal vasculature, myocardial tissue Doppler, and speckle tracking. The influence of cardiac loading conditions and the inter- and intraobserver variability limit the application of these image-based methods [13, 14]. Myocardial dysfunction occurs in a variety of fetal disorders. Since fetal blood sampling is technically challenging we investigated amniotic fluid nt-proBNP for its suitability to diagnose fetal myocardial dysfunction
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