B-Type Natriuretic Peptide in Pregnant Women With Heart Disease

Tanous, David; Siu, Samuel C.; Mason, Jennifer; Greutmann, Matthias; Wald, Rachel M.; Parker, John D.; Sermer, Mathew; Colman, Jack M.; Silversides, Candice K.

doi:10.1016/j.jacc.2010.02.076

Cited by 183 publications

(114 citation statements)

References 27 publications

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“…Although NT-proBNP level, a more stable biomarker in the blood than BNP, has also been shown to be elevated in women with preeclampsia [20 -22], to our knowledge there have been no previous studies regarding either NT-proBNP or BNP levels in otherwise healthy women with twin pregnancies. The results of the present study suggested that twin pregnancy should be added to the list of conditions in which increased NT-proBNP levels are anticipated that includes cardiopulmonary diseases [7,12,13], infection [23,24], and hypertensive disorders [20 -22] during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…Serum BNP levels increase in response to volume or pressure overload in the non-pregnant state [8 -10] as well as the normal pregnant state resulting in approximately twofold higher levels than in non-pregnant women [11], and pregnancies complicated with cardiac and/or pulmonary diseases [12,13] and preeclampsia [13 -19]. These studies regarding BNP levels during normal singleton pregnancies indicated that BNP levels, once elevated to approximately twofold those in non-pregnant state, do not change during pregnancy until term.…”

Section: Discussionmentioning

confidence: 99%

“…NT-proBNP concentration has been shown to provide information similar to BNP, and the validity of the assay as a clinical tool is well documented [7]. BNP and NT-proBNP levels in the blood increase in response to volume or pressure overload in the non-pregnant state [8 -10], as well as in the normal pregnant state [11] and in complicated pregnancies with cardiac and/or pulmonary diseases [12,13] or hypertensive disorder [13 -22]. However, neither NT-proBNP nor BNP level has been studied in women with twin pregnancy.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Serum levels of N-terminal fragment of precursor protein brain-type natriuretic peptide (NT-proBNP) in twin pregnancy

Yamada¹,

Koyama²,

Furuta³

et al. 2013

Clinica Chimica Acta

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Twin pregnancy differs considerably from singleton pregnancy in many aspects and it is unknown how serum NT-proBNP level behaves in women with twin pregnancies. Serum NT-proBNP levels were determined longitudinally at gestational weeks (GW) 24 and 35 in normotensive women with 13 twin and 99 singleton pregnancies. The effects of maternal demographic characteristics on NT-proBNP levels were also analyzed. The serum NT-proBNP levels (pg/mL) in twin pregnancies, which were not different from those in singleton pregnancies at 24 GW (26 ± 15 vs. 40±27, respectively, P = 0.0718), increased significantly (P = 0.0038) and were significantly higher than those in singleton pregnancies at 35 GW (72 ± 49 vs. 34 ± 24, P < 0.0001). In the analysis including women with singleton pregnancies, the serum levels of NT-proBNP at 35 GW were significantly inversely correlated with pre-pregnancy body mass index (BMI, kg/m 2 ) and were significantly higher in nulliparous than multiparous women. Thus, women with twin pregnancy were likely to exhibit an increase in serum NT-proBNP levels in the late stage of pregnancy, especially in lean and nulliparous women. The relative greater blood volume expansion occurring in twin than in singleton pregnancies was considered to be responsible for this phenomenon.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Serum levels of N-terminal fragment of precursor protein brain-type natriuretic peptide (NT-proBNP) in twin pregnancy

Yamada¹,

Koyama²,

Furuta³

et al. 2013

Clinica Chimica Acta

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“…47 Tanous et al demonstrated that a small group of 66 pregnant women with congenital and acquired heart disease revealed a median BNP level over twofold than that found in the control group of 12 healthy pregnant women. 48 Although this work is based on few patients and does not consider only patients affected by CHD, it permits to hypothesize that BNP strongly correlates with adverse cardiac events in CHD patients. Actually, in this work all the women who manifested an adverse cardiac outcome (defined as arrhythmia requiring treatment, stroke, cardiac arrest or cardiac death, pulmonary edema, decline of NHYA functional class by at least two classes, or need for urgent invasive cardiac procedures during pregnancy or within six months after delivery) had an elevated BNP (>100 pg/mL).…”

Section: Risk Factorsmentioning

confidence: 99%

Pregnancy and heart disease: what Internists should know

Gerloni

Panuccio²

2017

Ital J Med

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Cardiac disease can rarely complicate pregnancy (e.g., only 1 to 4% of pregnancies in the United States), but it still remains a major cause of non-obstetric maternal morbidity and mortality. 1 During pregnancy, a woman can suffer from heart failure because of a pre-existing heart disease or a new onset cardiopathy pregnancy correlated. Approximately 2% of pregnancies involve cardiac disease, and in the current era, most maternal disease is due to congenital heart disease (CHD).2 Currently cardiac surgery improvement of the last 50 years has permitted an increased number of survivors. Instead, in the past, rheumatic heart disease was the leading cause of heart failure in pregnancy.3,4 Further, with increasing maternal age, other etiologies of heart disease should not be ignored and, particularly, ischemic and hypertensive heart disease should be considered in an over forty pregnant women. 5 Physiology of normal pregnancyImportant hemodynamic changes appear during pregnancy and are responsible for heart failure in pregnant women with pre-existing heart disease. These changes begin early in pregnancy, generally during the first eight weeks, reach their peak during the late second trimester, and then remain relatively constant until delivery. 6 The plasma volume and red cell mass are the first major cardiocirculatory modification, actually they expand in the 8 th week and peak around 30 th week, with a net plasma volume gain of 1000-1600 mL, corresponding to 30-50% above baseline.7 A greater increase in intravascular volume compared to red cell mass results in the dilutional anemia of pregnancy. This aspect generally results at 30-34 weeks when plasma volume peaks in relation to red cell mass and is associated with sodium and water retention. Actually 1000 mEq of sodium and 6 liters of water are retained and distributed among amniotic fluid, fetus and intra and extracellular spaces.8 Further cardiac output increases to satisfy increase fetal and maternal metabolic needs. It can be estimated 30-50% above baseline levels during the entire pregnancy, but half of this change occurs by 8 th week. This relevant change is a consequence of blood volume augmentation, afterload reduction and maternal heart rate rise.9 Systemic Pregnancy and heart disease: what Internists should know ABSTRACTPregnant women with heart disease are increasing due to medical and surgical progress and, nowadays, congenital heart disease is the most frequent heart disease affecting these women. Pregnancy represents a considerable effort for an altered heart with negative consequences for life quality, disease progression and mortality. Risk differs a lot among patients and depends not only on the type of heart disease. Clinician should stratify risk and offer patients a correct pre-counselling and accurate follow-up. At the same time Clinician should be able to diagnose rapidly heart failure as some cardiopathies, such as peripartum cardiomyopathy, are related to pregnancy and produce symptoms that can be confused with normal pregnancy progression...

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“…(10) For more details on the specific prediction rules, we would like to refer to the original articles. (7,(9)(10)(11)(12) …”

Section: Risk Stratifi Cationmentioning

confidence: 99%

Pregnancy in women with congenital heart disease

Hagen

Roos‐Hesselink

2017

SAHJ

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With better access to health care, an accurate approximation of the increasing numbers of women with adult congenital heart disease in child-bearing age will become available. PRE-CONCEPTION COUNSELLINGAs pregnancy causes a haemodynamic burden, women known with congenital heart disease should be appropriately informed and advised, preferably before conception, thus at young age. The aim of pre-pregnancy counselling is to empower women to make informed choices about their plans to raise a family and to attempt to optimise the maternal condition pre-pregnancy with elective BACKGROUNDPregnancy is a challenge to the cardiovascular system even in healthy women. There are significant changes in circulating volume, arterial resistance, heart rate and structural changes in both the heart and great vessels. In structural heart disease, the capacity of

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B-Type Natriuretic Peptide in Pregnant Women With Heart Disease

Abstract: Many pregnant women with heart disease have increased BNP levels during pregnancy. Incorporating serial BNP levels in into clinical practice can be helpful, specifically in adjudicating suspected adverse cardiac events during pregnancy.

Cited by 183 publications

References 27 publications

Serum levels of N-terminal fragment of precursor protein brain-type natriuretic peptide (NT-proBNP) in twin pregnancy

Serum levels of N-terminal fragment of precursor protein brain-type natriuretic peptide (NT-proBNP) in twin pregnancy

Pregnancy and heart disease: what Internists should know

Pregnancy in women with congenital heart disease

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