Ultrasonographic and Biochemical Markers of Human Fetal Cardiac Dysfunction in Placental Insufficiency

Abstract

Background-Placental insufficiency may lead to fetal cardiovascular compromise. We sought to determine whether ultrasonographic parameters of fetal cardiovascular function correlate with umbilical arterial levels of biochemical markers of myocardial dysfunction and damage in placental insufficiency. Methods and Results-In 48 fetuses with placental insufficiency, umbilical artery blood was obtained at delivery for assessment of N-terminal peptide of proatrial natriuretic peptide (NT-proANP) and cardiac troponin-T (cTnT). Group 1 fetuses (nϭ12) had normal NT-proANP and cTnT serum concentrations. Group 2 fetuses (nϭ25) showed increased NT-proANP (Ͼ1145 pmol/L) and normal cTnT values. Group 3 fetuses (nϭ11) had increased NT-proANP and cTnT (Ͼ0.10 ng/mL) levels. The ultrasonographic parameters of fetal cardiovascular function were compared between the groups. Pulsatility indices for veins of the ductus venosus, left hepatic vein, and inferior vena cava correlated significantly with NT-proANP levels. In group 3, ductus venosus, left hepatic vein, and inferior vena cava pulsatility indices for veins were higher (PϽ0.01) than in groups 1 and 2. The proportion of left ventricular cardiac output of combined cardiac output was greater (PϽ0.05) and that of right ventricle was smaller (PϽ0.05) in group 3 than in group 2. In group 3, tricuspid regurgitation was noted most often (PϽ0.05), and right ventricular fractional shortening was less (PϽ0.01) than in group 2. Conclusions-Pulsatility in human fetal systemic veins correlated significantly with the cardiac secretion of ANP. Fetuses with myocardial damage demonstrate increased systemic venous pressure, a change in the distribution of cardiac output toward the left ventricle, and a rise in right ventricular afterload.

Human fetal cardiovascular profile score and neonatal outcome in intrauterine growth restriction

“…The CVP score includes fetal sonographic markers that have been correlated with poor perinatal outcome 14,15 . These markers were chosen for inclusion in the score because they combine mechanisms 16 by which the fetal circulation could fail in normal sinus rhythm.…”

“…Previous studies on growth-restricted fetuses have also suggested that abnormalities in fetal venous circulation are important indicators for the optimal timing of delivery 3,5,18 . Increased pulsatility in fetal systemic venous blood velocity waveforms is related to a rise in systemic venous pressure 19 , reflecting both ventricular compliance and ventricular end-diastolic pressure, and it has also been associated with biochemical evidence of cardiac dysfunction 15 . Tricuspid valve regurgitation reflects changes in right ventricular loading conditions.…”

“…Neonates with a CVP score ≤ 6 had significantly higher NT-proANP levels than had those with higher CVP scores. NT-proANP levels reflect distention of the fetal cardiac chambers and correlate with increased venous pressure 15,22 . Accordingly, we found that fetuses with umbilical venous pulsations demonstrated significantly higher NT-proANP levels than did fetuses with nonpulsatile umbilical venous flow.…”

Mechanism of Acute Fetal Cardiovascular Depression after Maternal Inflammatory Challenge in Mouse

“…33 In the present study, PIV in the ductus venosus was increased, suggesting a rise in systemic venous pressure. 34 Within 6 hours, 3 of the 26 fetuses in the LPS group were dead. Approximately 65% of the surviving fetuses had valve regurgitations present after LPS administration.…”

Use of cardiac biomarkers in neonatology

“…Prepartum evaluation of the pulsatility in fetal systemic veins significantly correlated to the cardiac secretion of ANP. Fetal myocardial compromise resulted in a distribution of cardiac output toward the left ventricle and a rise in the right-ventricular afterload, explaining the increase in ANP (38). Seong et al, in a study to evaluate the relationship between NT-proBNP levels and the method of delivery, found that infants with low Apgar scores and low umbilical cord blood pH appeared to have increased levels of NT-proBNP (18).…”