The relationship between amniotic fluid levels of brain-type natriuretic peptide and recipient cardiomyopathy in twin-twin transfusion syndrome.

Abstract

OBJECTIVE:

We sought to evaluate amniotic fluid brain natriuretic peptide (BNP) levels as a biomarker of recipient twin (RT) cardiomyopathy (RTCM) in twin-twin transfusion syndrome.

STUDY DESIGN:

Amniotic fluid samples were obtained from 157 twin-twin transfusion syndrome RTs and from 6 singletons (controls) from 2007 through 2009. N-terminal prohormone BNP (NT-proBNP) levels were quantified by enzyme-linked immunosorbent assay. RTCM was classified as mild (IIIA), moderate (IIIB), or severe (IIIC) by fetal echocardiography. The relationship between NT-proBNP and RTCM was evaluated using analysis of variance. The ability of NT-proBNP to predict moderate or greater RTCM was evaluated by receiver operating characteristic analysis.

RESULTS:

There is a significant positive correlation between NT-proBNP levels and worsening RTCM (r = 0.33; P < .001). NT-proBNP thresholds of 569 fmol/mg and 369 fmol/mg had a sensitivity of 70% and 87%, and specificity of 67% and 42%, respectively, in predicting moderate or greater RTCM.

CONCLUSION:

This is the first large case series that demonstrates a relationship between NT-proBNP and RTCM. This pathophysiologic insight supports ongoing efforts to develop screening biomarkers.

• Authors: Mounira Habli, James Cnota, Erik Michelfelder, Shelia Salisbury, Beverly Schnell, William Polzin, Foong Yen Lim, Timothy M Crombleholme
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 203 Issue 4 Pg. 404.e1-7 (Oct 2010) ISSN: 1097-6868 [Electronic] United States
• PMID: 20719292 (Publication Type: Journal Article)
• Copyright: Copyright © 2010 Mosby, Inc. All rights reserved.

Chemical References

• Biomarkers
• Peptide Fragments
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain

Topics

• Adult
• Amniotic Fluid (metabolism)
• Biomarkers (metabolism)
• Blood Flow Velocity
• Cardiomyopathies (diagnostic imaging, metabolism)
• Case-Control Studies
• Enzyme-Linked Immunosorbent Assay
• Female
• Fetofetal Transfusion (metabolism)
• Humans
• Natriuretic Peptide, Brain (metabolism)
• Peptide Fragments (metabolism)
• Pregnancy
• ROC Curve
• Retrospective Studies
• Sensitivity and Specificity
• Severity of Illness Index
• Ultrasonography, Doppler
• Umbilical Veins (diagnostic imaging)