Cardiac Troponin I and N-Terminal Pro-Brain Natriuretic Peptide in Umbilical Artery Blood in Relation to Fetal Heart Rate Abnormalities During Labor

Abstract

The use of continuous fetal heart rate (FHR) recordings to monitor fetal well-being during labor is standard clinical practice in developed countries. Little is known about the relationship, if any, that exists between these FHR abnormalities and the fetal cardiac musculature and function. The aim of this study was to investigate umbilical artery serum levels of cardiac troponin I, a sensitive and specific marker of myocardial necrosis, and N-terminal pro-brain natriuretic peptide (pro-BNP), a sensitive marker of left ventricular dysfunction, in relation to FHR abnormalities. Umbilical artery blood samples were taken from 27 cases immediately after delivery of the infant. There was evidence of significant FHR abnormalities in 11 of these cases (group 2) and the FHR recording was normal in 16 cases (group 1). The mean N-terminal pro-BNP level in umbilical artery serum in group 2 was 413 fmol/L (SEM = 85) and in group 1 was 223 fmol/L (SEM = 28)(p = 0.022). There was no significant difference observed in cardiac troponin I levels between the two groups. Umbilical artery serum N-terminal pro-BNP is elevated in association with fetal heart rate abnormality in the late stage of labor. This finding suggests that some degree of cardiac compromise accompanies FHR abnormality.

Cardiac toxicity of high-dose chemotherapy

“…121 Existing data suggest a strong correlation between natriuretic peptide measurement and myocardial dysfunction following standard dose anthracycline chemotherapy. 122,123 Importantly, unlike cTn's, BNP elevation may reflect chemotherapy-associated diastolic abnormalities 123,124 and the level may be increased by myocardial stress without necrosis, 125 thus potentially increasing their sensitivity over that afforded by cTn's. In the HD chemotherapy setting, patients who developed clinical heart failure exhibited elevated plasma BNP level in several measurements before the onset of signs/symptoms, although lesser elevations, and only on a single measurement were detected also in patients who did not experience cardiac toxicity.…”

Biochemical markers of neonatal myocardial dysfunction

“…Additionally, it may also help to regulate the blood supply to the fetus and modulate myocite growth during development [8,9]. As an alternative to BNP, NT-proBNP may have some advantages, namely a longer half-life and greater stability [10,11]. Natriuretic peptides are thought not to cross the placenta and therefore any variation in neonates must be explained intrinsically [7].…”

N-Terminal-pro-B Type Natriuretic Peptide as a Useful Tool to Evaluate Pulmonary Hypertension and Cardiac Function in CDH Infants

“…However, in children the knowledge about the significance of plasma levels of NT-proBNP is still limited. In healthy children, studies have shown that NT-proBNP levels are elevated soon after birth reaching its peak at 24 h of life decreasing thereafter up to 4 months and remaining unchanged until the age of 15 [15][16][17][18][19] . NT-proBNP levels are elevated in children with congenital heart disease or cardiomyopathy [20][21][22] .…”