Intra‐amniotic N‐terminal pro‐brain natriuretic peptide in severe twin‐to‐twin transfusion syndrome treated by fetoscopic laser coagulation

Delabaere, Amélie; Marceau, Geoffroy; Kemeny, Steven Frank; Sapin, Vincent; Ughetto, Sylvie; Coste, Karen; Gallot, D.

doi:10.1002/uog.7579

Cited by 12 publications

(10 citation statements)

References 10 publications

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“…Here, concentrations correlated with the degree of myocardial dysfunction or disease severity. However, controls were either not available or of small sample size [39–41]. A further study reported on amniotic fluid and umbilical cord BNP at delivery in monochorionic twin pregnancies, whereby higher levels were present in newborns with weight discordance >20% or myocardial dysfunction [42].…”

Section: Discussionmentioning

confidence: 99%

N-terminal pro-B-type natriuretic peptide in amniotic fluid of fetuses with known or suspected cardiac load

et al. 2017

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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.

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Section: Discussionmentioning

confidence: 99%

N-terminal pro-B-type natriuretic peptide in amniotic fluid of fetuses with known or suspected cardiac load

et al. 2017

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“…Increased endothelin-1 [44], brain or b-type natriuretic peptide (BNP) [28, 44, 45] and cardiac troponin T [28] levels have been observed in the plasma and/or the amniotic fluid of recipient fetuses, similar to observations in adults with chronic heart failure. Endothelin-1 can certainly play a role in the development of the severe hypertension [35, 44], stimulates the myocardial remodeling [46] and could decrease cardiac function.…”

Section: Biomarkers Of Altered Fetal Hemodynamics In Tttsmentioning

confidence: 93%

The Fetal Heart in Twin-to-Twin Transfusion Syndrome

Mieghem

Lewi

Gucciardo

et al. 2010

International Journal of Pediatrics

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Twin-to-twin transfusion syndrome is a severe complication occurring in 10% of monochorionic twin pregnancies. The disease is usually explained as due to an intrauterine imbalance in intertwin blood exchange, which leads to a volume depleted-donor twin and an overfilled recipient twin. The recipient has signs of cardiac dysfunction, which can be measured using echocardiography or blood and amniotic fluid derived biomarkers. Whereas cardiac dysfunction typically progresses in pregnancies treated with amniodrainage, it usually disappears within a few weeks after fetoscopic laser coagulation of the connecting intertwin anastomoses. Nevertheless, recipients remain at a increased risk of pulmonary stenosis. In this paper, we summarize the cardiac alterations in twin-to-twin transfusion syndrome, describe the changes seen after fetal therapy, list the newly proposed staging systems based on fetal cardiac function, and make recommendations about the use of fetal echocardiography in the evaluation and followup of pregnancies complicated by twin-to-twin transfusion syndrome.

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“…Additionally, access to the amniotic cavity is part of various intrauterine interventions. Three publications have reported NT‐proBNP concentrations in amniotic fluid samples in TTTS. All investigators found a good correlation between amniotic fluid NT‐proBNP levels and parameters of TTTS (Quintero stage, echocardiography, Doppler findings).…”

Section: Implications Of Circulating Molecular Forms Nt‐probnp In Ammentioning

confidence: 97%

Old tool – new application: NT‐proBNP in fetal medicine

Merz

Gembruch

2014

Ultrasound in Obstet & Gyne

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Intra‐amniotic N‐terminal pro‐brain natriuretic peptide in severe twin‐to‐twin transfusion syndrome treated by fetoscopic laser coagulation

Cited by 12 publications

References 10 publications

N-terminal pro-B-type natriuretic peptide in amniotic fluid of fetuses with known or suspected cardiac load

N-terminal pro-B-type natriuretic peptide in amniotic fluid of fetuses with known or suspected cardiac load

The Fetal Heart in Twin-to-Twin Transfusion Syndrome

Old tool – new application: NT‐proBNP in fetal medicine

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