Reference values for N-terminal pro-B-type natriuretic peptide in fetal circulation between 20 and 34 weeks of gestation

Merz, Waltraut M.; Kübler, Kirsten; Albers, Eike; Stoffel‐Wagner, Birgit; Gembruch, Ulrich

doi:10.1016/j.clinbiochem.2009.11.012

Cited by 17 publications

(22 citation statements)

References 15 publications

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“…Cystatin C, ß 2 -microglobulin and GA-adapted hemoglobin concentrations are listed in Table 2. Compared to fetal reference values [19], [20] cystatin C and ß 2 -microglobulin were found to be increased. Additionally, cystatin C and ß 2 -microglobulin concentrations were significantly higher in bilateral renal agenesis compared to obstructive uropathies (p = 0.005 and p<0.001, respectively).…”

Section: Resultsmentioning

confidence: 58%

Cardiorenal Syndrome is Present in Human Fetuses with Severe, Isolated Urinary Tract Malformations

et al. 2013

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ObjectiveWe analyzed the association between renal and cardiovascular parameters in fetuses with isolated severe urinary tract malformations.Methods39 fetuses at a mean gestational age of 23.6 weeks with nephropathies or urinary tract malformations and markedly impaired or absent renal function were prospectively examined. Fetal echocardiography was performed, and thicknesses of the interventricular septum, and left and right ventricular wall were measured. Blood flow velocity waveforms of the umbilical artery, middle cerebral artery, and ductus venosus were obtained by color Doppler ultrasound. Concentrations of circulating n-terminal pro-B-type natriuretic peptide (nt-proBNP), cystatin C, ß2-microglobulin, and hemoglobin were determined from fetal blood samples.ResultsMalformations included 21 cases of obstructive uropathy, 10 fetuses with bilateral nephropathy, and 8 cases of bilateral renal agenesis. Marked biventricular myocardial hypertrophy was present in all cases. The ratio between measured and gestational age-adjusted normal values was 2.01 (interventricular septum), 1.85, and 1.78 (right and left ventricular wall, respectively). Compared to controls, levels of circulating nt-proBNP were significantly increased (median (IQR) 5035 ng/L (5936 ng/L) vs. 1874 ng/L (1092 ng/L); p<0.001). Cystatin C and ß2-microglobulin concentrations were elevated as follows (mean ± SD) 1.85±0.391 mg/L and 8.44±2.423 mg/L, respectively (normal range 1.66±0.202 mg/L and 4.25±0.734 mg/L, respectively). No correlation was detected between cardiovascular parameters and urinary tract morphology and function. Despite increased levels of nt-proBNP cardiovascular function was preserved, with normal fetal Doppler indices in 90.2% of cases.ConclusionUrinary tract malformations resulting in severe renal impairment are associated with biventricular myocardial hypertrophy and elevated concentrations of circulating nt-proBNP during fetal life. Cardiovascular findings do not correlate with kidney function or morphology.

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Section: Resultsmentioning

confidence: 58%

Cardiorenal Syndrome is Present in Human Fetuses with Severe, Isolated Urinary Tract Malformations

et al. 2013

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“…As compared with postnatal life, nt-proBNP concentrations are higher in the human fetus (8). The difference is not because of maternal/placental transfer or differences in metabolic pathways (7,9) but may be a consequence of the reduced compliance of the immature fetal myocardium.…”

Section: Discussionmentioning

confidence: 84%

“…The difference is not because of maternal/placental transfer or differences in metabolic pathways (7,9) but may be a consequence of the reduced compliance of the immature fetal myocardium. Parallel to the decrease in left-ventricular afterload with advancing gestation and maturation of the fetal myocardium, plasma levels gradually decrease (8). Placental expression of atrial natriuretic peptide, but not BNP, has been proven and may be involved in vasodilatation of the feto-placental vascular bed (7).…”

Section: Discussionmentioning

confidence: 99%

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Circulating N-terminal pro-B-type natriuretic peptide in fetal anemia before and after treatment

et al. 2012

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Background: N-terminal pro-B-type natriuretic peptide (ntproBNP) is an established marker of heart failure in adult cardiology. We analyzed nt-proBNP in the circulation of fetuses with increased volume load secondary to anemia and investigated the effect of treatment on nt-proBNP concentration. Methods: Fetuses undergoing intrauterine transfusion (IUT) were examined. nt-proBNP was measured before IUT and correlated with hemoglobin concentrations, ultrasonographic findings, and Doppler measurements of the peak systolic velocity of the middle cerebral artery (Mca-PsV). Results: a total of 27 patients (7 with hydrops) and 78 controls were examined. nt-proBNP was markedly elevated in anemia (P < 0.001). concentrations were highest in hydropic fetuses (P < 0.03); no differences were present in hemoglobin and Mca-PsV values between hydropic and nonhydropic cases. In fetuses undergoing multiple IUTs nt-proBNP normalized after the third IUT, whereas hemoglobin and Mca-PsV remained abnormal. Conclusion: Levels of circulating nt-proBNP correlate well with the degree of myocardial workload in the hyperdynamic state of fetal anemia. We hypothesize that normalization of nt-proBNP after serial transfusions is an indicator of myocardial adjustment to chronic anemia. nt-proBNP measurement may be useful in the management of fetal anemia, particularly in cases at risk of hydrops and fetuses requiring multiple transfusions.

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“…Maternal exclusion criteria were the presence of cardiac or renal diseases. Inclusion and exclusion criteria for controls have been described in detail [35, 36]. …”

Section: Methodsmentioning

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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Reference values for N-terminal pro-B-type natriuretic peptide in fetal circulation between 20 and 34 weeks of gestation

Cited by 17 publications

References 15 publications

Cardiorenal Syndrome is Present in Human Fetuses with Severe, Isolated Urinary Tract Malformations

Cardiorenal Syndrome is Present in Human Fetuses with Severe, Isolated Urinary Tract Malformations

Circulating N-terminal pro-B-type natriuretic peptide in fetal anemia before and after treatment

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

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