From the Departments of Cardiology, Harvard Medical School, Boston, MA, USA.
Brigham and Women's Hospital; and the Departments of Pediatrics, Harvard Medical School, Boston, MA, USA.
Prenat Diagn. 2018 Feb;38(3):190-195. doi: 10.1002/pd.5213. Epub 2018 Feb 6.
Fetal aortic stenosis (AS) imposes pressure load on the developing left ventricle (LV) and leads to derangements in myocardial structure and function via mechanisms that are not well characterized.
We compared amniotic fluid NT-BNP and troponin levels in fetuses with AS prior to fetal valvuloplasty and controls. We estimated correlations between NT-BNP and fetal echo parameters and identify NT-BNP cutoff associated with biventricular outcome RESULTS: Median NT-BNP level was higher in fetal AS than controls (3858 vs 1737 pg/mL, P < 0.012). By contrast, troponin levels were lower in fetal AS, with troponin > detectable in 0/25 (0%) AS cases compared with 22/85 (26%) controls (P = 0.03). Of 25 fetal AS cases, 12 (48%) had biventricular outcome. Fetuses with NT-BNP < 910 pg/mL were more likely to have biventricular (OR =10) compared with those ≥910 pg/mL (P = 0.045). Higher NT-BNP correlated with earlier gestational age and measures of larger left heart size.
NT-BNP is elevated in fetal AS, suggesting that LV pressure load and increased wall stress lead to maladaptive stretch-related myocardial remodeling. Troponin is normal in mid-gestation fetal AS, suggesting that ischemia is not the primary factor in fetal response to LV pressure load.
胎儿主动脉瓣狭窄（AS）会对左心室（LV）施加压力负荷，通过尚未明确的机制导致心肌结构和功能紊乱。
我们比较了胎儿 AS 行胎儿瓣膜成形术前后的羊水 NT-BNP 和肌钙蛋白水平，并评估了 NT-BNP 与胎儿超声心动图参数之间的相关性，以确定与双心室结局相关的 NT-BNP 临界值。
胎儿 AS 组的 NT-BNP 中位数高于对照组（3858 比 1737 pg/mL，P < 0.012）。相比之下，胎儿 AS 组的肌钙蛋白水平较低，25 例胎儿 AS 中有 0/25 例（0%）的肌钙蛋白>可检测，而 85 例对照组中有 22/85 例（26%）（P = 0.03）。在 25 例胎儿 AS 中，有 12 例（48%）存在双心室结局。与 NT-BNP ≥910 pg/mL 的胎儿相比，NT-BNP <910 pg/mL 的胎儿更有可能出现双心室结局（OR = 10，P = 0.045）。较高的 NT-BNP 与较早的胎龄和左心增大的指标相关。
胎儿 AS 中 NT-BNP 升高，提示 LV 压力负荷和壁应力增加导致适应性伸展相关的心肌重塑。中孕期胎儿 AS 中的肌钙蛋白正常，提示缺血不是 LV 压力负荷对胎儿反应的主要因素。
