Fetal aortic stenosis and changes in amniotic fluid natriuretic peptides

Myocardial injury in fetal aortic stenosis: Insights from amniotic fluid analysis

“…This is the first study to report elevated NT‐BNP in response to LV pressure load in the human fetus. Our results are in agreement with prior studies that have shown higher BNP in human fetuses with volume loading lesions and in animal models of LV pressure load . In adults with AS, greater LV pressure leads to increased ventricular wall stress and myocyte stretch, both of which are responsible for adverse remodeling.…”

“…Amniotic fluid BNP has been shown to correlate with fetal blood BNP levels and to be elevated in fetal volume overload states, including twin‐twin transfusion and congenital cardiac defects . In a fetal sheep model of supravalvar AS, amniotic fluid BNP levels were elevated compared with controls and the degree of BNP elevation correlated with AS severity and LV hypertrophy …”

“…16,17 In a fetal sheep model of supravalvar AS, amniotic fluid BNP levels were elevated compared with controls and the degree of BNP elevation correlated with AS severity and LV hypertrophy. 18 In this study we evaluate if NT-BNP and troponin are elevated in mid-gestation fetuses with severe AS. Additionally, we evaluate whether NT-BNP or troponin is predictive of postnatal circulatory outcome or associated with fetal echo parameters.…”

Fetal cardiac intervention—Perspectives from a single center

“…Animal models, however, have suggested that severe AS and associated left ventricular hypertrophy are instead associated with an increase in brain natriuretic peptide (BNP). 51 By measuring both troponin and N-terminus brain pro-natriuretic peptide (NT-BNP) in the amniotic fluid of patients with AS-eHLHS at the time of FCI, our group has been able to show no elevation of troponin levels in fetal AS relative to controls, whereas NT-BNP levels are elevated and correlate with echocardiographic markers of disease severity. These findings suggest that the radiographic and pathologic changes seen in progressive HLHS may be more the result of the chronic pressure load and ventricular stretch, as opposed to ischemia-as is seen more commonly in the adult heart failure population.…”

“…In adults, these changes are often seen in the setting of tissue injury following ischemia, which is associated with an elevation in the biomarker, troponin. Animal models, however, have suggested that severe AS and associated left ventricular hypertrophy are instead associated with an increase in brain natriuretic peptide (BNP) . By measuring both troponin and N‐terminus brain pro‐natriuretic peptide (NT‐BNP) in the amniotic fluid of patients with AS‐eHLHS at the time of FCI, our group has been able to show no elevation of troponin levels in fetal AS relative to controls, whereas NT‐BNP levels are elevated and correlate with echocardiographic markers of disease severity.…”