Departments of Medicine and Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, Rhode Island; and the Department of Medicine, Harvard Medical School, Brigham and Women's Cardiovascular Associates of Care New England, Boston, Massachusetts.
Obstet Gynecol. 2019 Sep;134(3):440-449. doi: 10.1097/AOG.0000000000003419.
To evaluate the performance of B-type natriuretic peptide as a diagnostic tool for heart failure in pregnant or postpartum women with singleton gestations.
We conducted a retrospective study of diagnostic accuracy. We identified pregnant and postpartum women with B-type natriuretic peptide and echocardiography performed at an obstetric teaching hospital from 2007 to 2018. Women with known cardiac disease or multiple gestation were excluded. A panel of two cardiovascular disease experts, blinded to B-type natriuretic peptide values, determined the diagnosis of heart failure by consensus. Their judgement was based on detailed clinical features and parameters at the time of presentation with suspected heart failure. Where consensus could not be reached, differences were adjudicated by a third expert. A receiver operating characteristic curve estimated the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of B-type natriuretic peptide at various thresholds.
In total, 22 pregnant and 38 postpartum women were included in the cohort. Average age was 32±6.8 years. The most common clinical features at the time of presentation with suspected heart failure included preeclampsia (33/60, 55%), dyspnea (50/60, 83%), chest discomfort (34/60, 58%), and bilateral lower extremity edema (32/60, 53%). In total, 39 (65%) women had heart failure. The median B-type natriuretic peptide level was 326 pg/mL (interquartile range 200.5-390.5) in women with heart failure, as compared with 75.5 pg/mL (interquartile range 19-245) in women without heart failure (P<.01). The estimated optimal B-type natriuretic peptide cutoff was 111 (95% CI 78-291) pg/mL. Using this threshold, 45 (75%) women had an elevated B-type natriuretic peptide, which yielded a 95% sensitivity (95% CI 83-99), 62% specificity (95% CI 38-82), a positive likelihood ratio of 2.5 (95% CI 1.4-4.3), and a negative likelihood ratio of 0.1 (95% CI 0.0-0.3) for heart failure.
B-type natriuretic peptide is a useful clinical tool to evaluate pregnant and postpartum women with suspected heart failure.
评估 B 型利钠肽作为诊断工具在患有单胎妊娠的孕妇或产后妇女心力衰竭中的性能。
我们进行了一项诊断准确性的回顾性研究。我们从 2007 年至 2018 年在一家产科教学医院中识别出进行了 B 型利钠肽和超声心动图检查的孕妇和产后妇女。患有已知心脏病或多胎妊娠的妇女被排除在外。由两名心血管疾病专家组成的小组，对 B 型利钠肽值进行盲法评估，通过共识确定心力衰竭的诊断。他们的判断基于可疑心力衰竭发作时的详细临床特征和参数。如果无法达成共识，则由第三位专家进行裁决。接受者操作特征曲线估计了 B 型利钠肽在各种阈值下的敏感性、特异性、阳性似然比和阴性似然比。
共有 22 名孕妇和 38 名产后妇女被纳入该队列。平均年龄为 32±6.8 岁。可疑心力衰竭发作时最常见的临床特征包括子痫前期（33/60，55%）、呼吸困难（50/60，83%）、胸痛（34/60，58%）和双侧下肢水肿（32/60，53%）。共有 39 名（65%）妇女患有心力衰竭。心力衰竭患者的中位 B 型利钠肽水平为 326 pg/mL（四分位距 200.5-390.5），而无心力衰竭患者的中位 B 型利钠肽水平为 75.5 pg/mL（四分位距 19-245）（P<.01）。估计的最佳 B 型利钠肽截止值为 111（95%CI 78-291）pg/mL。使用此阈值，45 名（75%）妇女的 B 型利钠肽升高，其敏感性为 95%（95%CI 83-99），特异性为 62%（95%CI 38-82），阳性似然比为 2.5（95%CI 1.4-4.3），阴性似然比为 0.1（95%CI 0.0-0.3）。
B 型利钠肽是评估疑似心力衰竭的孕妇和产后妇女的有用临床工具。
