Division of Cardiology, St. Paul's Hospital (S.A.C., M.J., M.K., J.G.), University of British Columbia, Vancouver, Canada.
Faculty of Medicine (P.K.), University of British Columbia, Vancouver, Canada.
Circ Heart Fail. 2022 Aug;15(8):e009018. doi: 10.1161/CIRCHEARTFAILURE.121.009018. Epub 2022 Jul 29.
Clinical utility of cardiac biomarker testing during pregnancy in women with preexisting cardiac disease is not well known. We studied the levels and temporal trends of NT-proBNP (N-terminal pro-B-type natriuretic peptide) and hs-cTnI (high-sensitivity cardiac troponin I) throughout pregnancy in women with preexisting cardiac disease and sought to assess the association between NT-proBNP and hs-cTnI and pregnancy outcomes.
Three hundred seven pregnant women with preexisting cardiac disease were prospectively recruited. Mixed-effects linear regression analysis was used to compare the NT-proBNP and hs-cTnI levels between time periods and subgroups. Logistic regression analysis adjusted for maternal age and CARPREG II (Cardiac Disease in Pregnancy) risk score assessed the association between NT-proBNP levels and adverse events.
Geometric mean NT-proBNP (95% CI) was stable through pregnancy with a transient significant increase with labor and delivery (101.4 pg/mL [87.1-118.1], 90.2 pg/mL [78.5-103.6], 153.6 pg/mL [126.8-186.1], and 112.2 pg/mL [94.2-133.7] for first/second trimester, third trimester, labor/delivery and postpartum, respectively). We observed a statistically significant difference in the NT-proBNP between women with preserved versus decreased systemic ventricular function, structurally normal versus abnormal heart, modified World Health Organization class 1, 2 versus modified World Health Organization class 3, 4 and no congenital heart disease versus congenital heart disease. Compared to those without events, median (interquartile range) NT-proBNP levels were significantly higher in those who had heart failure (204 pg/mL [51-450] versus 55 pg/mL [31-97]; =0.001) and preeclampsia (98 pg/mL [40-319] versus 55 pg/mL [31-99]; =0.027). NT-proBNP, adjusted for age and CARPREG II risk score, was significantly associated with combined heart failure and preeclampsia (adjusted odds ratio, 2.14 [95% CI, 1.48-3.10] per log NT-proBNP increase; <0.001). NT-proBNP <200 pg/mL had a specificity of 91% and negative predictive value of 95% in predicting combined heart failure and preeclampsia.
NT-proBNP remains steady over the course of pregnancy with a transient increase during labor and delivery with higher levels in subgroups of stable cardiac patients. NT-proBNP level of 200 pg/mL can be used in the diagnosis of heart failure/preeclampsia in the pregnant cardiac population.
在患有基础心脏病的孕妇中，心脏生物标志物检测的临床效用尚不清楚。我们研究了患有基础心脏病的孕妇在整个怀孕期间 N 末端 B 型利钠肽前体（N-terminal pro-B-type natriuretic peptide，NT-proBNP）和高敏心肌肌钙蛋白 I（high-sensitivity cardiac troponin I，hs-cTnI）的水平和时间趋势，并试图评估 NT-proBNP 和 hs-cTnI 与妊娠结局之间的关系。
前瞻性招募了 307 名患有基础心脏病的孕妇。混合效应线性回归分析用于比较不同时间段和亚组之间的 NT-proBNP 和 hs-cTnI 水平。使用调整了母体年龄和 CARPREG II（妊娠心脏疾病）风险评分的 logistic 回归分析评估了 NT-proBNP 水平与不良事件之间的关系。
NT-proBNP 的几何平均值（95%置信区间）在整个怀孕期间保持稳定，分娩时短暂显著增加（第一/二孕期为 101.4 pg/mL [87.1-118.1]、第三孕期为 90.2 pg/mL [78.5-103.6]、分娩时为 153.6 pg/mL [126.8-186.1]和产后为 112.2 pg/mL [94.2-133.7]）。我们观察到 NT-proBNP 在具有保存性与降低性系统性心室功能、结构正常与异常心脏、改良的世界卫生组织 1 级、2 级与改良的世界卫生组织 3 级、4 级以及无先天性心脏病与先天性心脏病的患者之间存在显著差异。与无事件患者相比，心力衰竭患者的中位（四分位距）NT-proBNP 水平显著升高（204 pg/mL [51-450] 与 55 pg/mL [31-97]；=0.001），子痫前期患者的中位（四分位距）NT-proBNP 水平也显著升高（98 pg/mL [40-319] 与 55 pg/mL [31-99]；=0.027）。NT-proBNP 经年龄和 CARPREG II 风险评分调整后，与心力衰竭和子痫前期的合并发生显著相关（调整后的优势比，每增加 log NT-proBNP 1 个单位，为 2.14 [95%置信区间，1.48-3.10]；<0.001）。NT-proBNP<200 pg/mL 对预测心力衰竭和子痫前期合并发生的特异性为 91%，阴性预测值为 95%。
NT-proBNP 在整个怀孕期间保持稳定，分娩时短暂增加，稳定型心脏患者的水平较高。200 pg/mL 的 NT-proBNP 水平可用于诊断妊娠合并心力衰竭和子痫前期的患者。
