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Takano M, Hine K, Nagasaki S, Sakuma J, Shimabukuro M, Kotaki H, Saito K, Ogata K, Yoda H, Nakata M. Different expressions of cardiac biomarkers between different types of acquired right ventricular outflow tract abnormality in monochorionic twins. Prenat Diagn 2022; 42:1448-1457. [PMID: 36081332 DOI: 10.1002/pd.6236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/17/2022] [Accepted: 09/05/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the differences in amniotic fluid cardiac biomarkers and clinical features among types of right ventricular outflow tract (RVOT) abnormality in monochorionic (MC) twins. METHOD This prospective study included MC twins that underwent laser surgery. Recipient or larger twins (group A) and donor or smaller twins (group B) were assessed and divided into those with a normal right ventricular outflow tract (normal RVOT), functional pulmonary atresia (fPA), or pulmonary stenosis (PS). Amniotic fluid levels of NT-proBNP (afNT-proBNP) and cardiac troponin T (afTnT) were examined during surgery. RESULTS Of 190 fetuses in group A, there were 14 RVOT abnormality cases (including 7 fPA and 7 PS). No group B fetuses showed RVOT abnormality findings. In group A, later and earlier gestational age at surgery were observed in fPA (25.1±2.8 weeks) and PS groups (17.8±0.9 weeks). All survived PS cases demonstrated progressive pulmonary valve obstruction, not observed in fPA groups. AfNT-proBNP were significantly higher in fPA and PS than in normal RVOT group (p<0.05). AfTnT was significantly higher in group A with PS than fPA and normal RVOT groups (p<0.05). CONCLUSION Among RVOT abnormality types in group A, amniotic fluid cardiac biomarkers were differently expressed, and clinical features were also differentiated. These findings provide insight into the pathophysiological influence on RVOT in MC twins. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mayumi Takano
- Department of Obstetrics and Gynecology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Kotaro Hine
- Department of Neonatology, Toho University Faculty of Medicine, Tokyo, Japan.,Department of Neonatology, Toho University Omori Medical Center, Tokyo, Japan
| | - Sumito Nagasaki
- Department of Obstetrics and Gynecology, Toho University Faculty of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, T, oho University Omori Medical Center, Tokyo, Japan
| | - Junya Sakuma
- Department of Obstetrics and Gynecology, Toho University Faculty of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, T, oho University Omori Medical Center, Tokyo, Japan
| | - Makiko Shimabukuro
- Department of Obstetrics and Gynecology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Hikari Kotaki
- Department of Obstetrics and Gynecology, Toho University Faculty of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, T, oho University Omori Medical Center, Tokyo, Japan
| | - Keiko Saito
- Department of Neonatology, Toho University Faculty of Medicine, Tokyo, Japan.,Department of Neonatology, Toho University Omori Medical Center, Tokyo, Japan
| | - Kohei Ogata
- Department of Neonatology, Toho University Faculty of Medicine, Tokyo, Japan.,Department of Neonatology, Toho University Omori Medical Center, Tokyo, Japan
| | - Hitoshi Yoda
- Department of Neonatology, Toho University Faculty of Medicine, Tokyo, Japan.,Department of Neonatology, Toho University Omori Medical Center, Tokyo, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University Faculty of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, T, oho University Omori Medical Center, Tokyo, Japan
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Schuchardt EL, Miyamoto SD, Crombleholme T, Karimpour-Fard A, Korst A, Neltner B, Howley LW, Cuneo B, Sucharov CC. Amniotic Fluid microRNA in Severe Twin-Twin Transfusion Syndrome Cardiomyopathy-Identification of Differences and Predicting Demise. J Cardiovasc Dev Dis 2022; 9:37. [PMID: 35200691 PMCID: PMC8878714 DOI: 10.3390/jcdd9020037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/10/2022] [Accepted: 01/18/2022] [Indexed: 12/15/2022] Open
Abstract
Twin-twin transfusion syndrome (TTTS) is a rare but serious cause of fetal cardiomyopathy with poorly understood pathophysiology and challenging prognostication. This study sought a nonbiased, comprehensive assessment of amniotic fluid (AF) microRNAs from TTTS pregnancies and associations of these miRNAs with clinical characteristics. For the discovery cohort, AF from ten fetuses with severe TTTS cardiomyopathy were selected and compared to ten normal singleton AF. Array panels assessing 384 microRNAs were performed on the discovery cohort and controls. Using a stringent q < 0.0025, arrays identified 32 miRNAs with differential expression. Top three microRNAs were miR-99b, miR-370 and miR-375. Forty distinct TTTS subjects were selected for a validation cohort. RT-PCR targeted six differentially-expressed microRNAs in the discovery and validation cohorts. Expression differences by array were confirmed by RT-PCR with high fidelity. The ability of these miRNAs to predict clinical differences, such as cardiac findings and later demise, was evaluated on TTTS subjects. Down-regulation of miRNA-127-3p, miRNA-375-3p and miRNA-886 were associated with demise. Our results indicate AF microRNAs have potential as a diagnostic and prognostic biomarker in TTTS. The top microRNAs have previously demonstrated roles in angiogenesis, cardiomyocyte stress response and hypertrophy. Further studies of the mechanism of actions and potential targets is warranted.
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Affiliation(s)
- Eleanor L. Schuchardt
- Department of Pediatrics, Colorado Fetal Care Center, Children’s Hospital Colorado, School of Medicine, University of Colorado, Aurora, CO 80045, USA; (E.L.S.); (S.D.M.); (B.C.)
- Department of Pediatrics, Rady Children’s Hospital, School of Medicine, University of California San Diego, San Diego, CA 92123, USA
| | - Shelley D. Miyamoto
- Department of Pediatrics, Colorado Fetal Care Center, Children’s Hospital Colorado, School of Medicine, University of Colorado, Aurora, CO 80045, USA; (E.L.S.); (S.D.M.); (B.C.)
| | - Timothy Crombleholme
- Fetal Care Center Dallas, Medical City Children’s Hospital, Dallas, TX 75230, USA;
| | - Anis Karimpour-Fard
- Department of Pharmacology, School of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA;
| | - Armin Korst
- Research Institute, Children’s Hospital Colorado, Aurora, CO 80045, USA;
| | - Bonnie Neltner
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Lisa W. Howley
- Division of Cardiology, Department of Pediatrics, The Children’s Heart Clinic, Children’s Minnesota, Minneapolis, MN 55404, USA;
| | - Bettina Cuneo
- Department of Pediatrics, Colorado Fetal Care Center, Children’s Hospital Colorado, School of Medicine, University of Colorado, Aurora, CO 80045, USA; (E.L.S.); (S.D.M.); (B.C.)
| | - Carmen C. Sucharov
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA;
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Willner EC, Galan HL, Cuneo BF, Hoffman HA, Neltner B, Schuchardt EL, Karimpour-Fard A, Miyamoto SD, Sucharov CC. Amniotic fluid microRNA profiles in twin-twin transfusion syndrome with and without severe recipient cardiomyopathy. Am J Obstet Gynecol 2021; 225:439.e1-439.e10. [PMID: 34153234 DOI: 10.1016/j.ajog.2021.06.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/26/2021] [Accepted: 06/08/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Twin-twin transfusion syndrome presents many challenges for clinicians, and the optimal means of identifying pregnancies that will benefit most from intervention is controversial. There is currently no clinically available biomarker to detect twin-twin transfusion syndrome or to stratify cases based on the risk factors. microRNAs are small RNAs that regulate gene expression and are biomarkers for various disease processes, including adult and pediatric heart failure. To date, no studies have investigated amniotic fluid microRNAs as biomarkers for disease severity, specifically for severe recipient cardiomyopathy in twin-twin transfusion syndrome cases. OBJECTIVE This study aimed to assess whether amniotic fluid microRNAs could be useful as biomarkers to identify pregnancies at greatest risk for severe recipient cardiomyopathy associated with twin-twin transfusion syndrome. STUDY DESIGN Amniotic fluid was collected at the time of amnioreduction or selective fetoscopic laser photocoagulation from monochorionic diamniotic twin pregnancies with twin-twin transfusion syndrome at any stage. Fetal echocardiography was performed on all twins before the procedure, and severe cardiomyopathy was defined as a right ventricular myocardial performance index of the recipient fetus of >4 Z-scores. microRNA was extracted from the amniotic fluid samples and analyzed using an array panel assessing 379 microRNAs (TaqMan Open Array, ThermoFisher). Student t tests were performed to determine significant differences in microRNA expression between pregnancies with severe recipient cardiomyopathy and those with preserved cardiac function. A stringent q value of <.0025 was used to determine differential microRNA expression. Random forest plots identified the top 3 microRNAs that separated the 2 groups, and hierarchical cluster analysis was used to determine if these microRNAs properly segregated the samples according to their clinical groups. RESULTS A total of 14 amniotic fluid samples from pregnancies with twin-twin transfusion syndrome with severe cardiomyopathy were compared with samples from 12 twin-twin transfusion syndrome control cases with preserved cardiac function. A total of 110 microRNAs were identified in the amniotic fluid samples. Twenty microRNAs were differentially expressed, and the top 3 differentiating microRNAs were hsa-miR-200c-3p, hsa-miR-17-5p, and hsa-miR-539-5p. Hierarchical cluster analysis based on these top 3 microRNAs showed a strong ability to differentiate severe cardiomyopathy cases from controls. The top 3 microRNAs were used to investigate the sensitivity and specificity of these microRNAs to differentiate between the 2 groups with a receiver operating characteristic curve demonstrating sensitivity and specificity of 80.8%. All 20 differentially expressed microRNAs were down-regulated in the group with severe cardiomyopathy. CONCLUSION Amniotic fluid microRNAs demonstrated differential expression between twin-twin transfusion syndrome recipient fetuses with severe cardiomyopathy and those without and have the potential to be important biomarkers of disease severity in this population.
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Affiliation(s)
- Emily C Willner
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO
| | - Henry L Galan
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, CO
| | - Bettina F Cuneo
- Division of Cardiology, Department of Pediatrics, Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, CO
| | - Hilary A Hoffman
- Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, CO
| | - Bonnie Neltner
- Division of Cardiology, University of Colorado, Aurora, CO
| | - Eleanor L Schuchardt
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO; Division of Cardiology, Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, CA
| | | | - Shelley D Miyamoto
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Carmen C Sucharov
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora, CO.
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Abstract
Twin to twin transfusion syndrome (TTTS) is a common complication that typically presents in the second trimester of pregnancy in 10-15% of monochorionic twins due to net transfer of volume and hormonal substances from one twin to the other across vascular anastomoses on the placenta. Without recognition and treatment, TTTS is the greatest contributor to fetal loss prior to viability in 90-100% of advanced cases. Ultrasound diagnosis of monochorionicity is most reliable in the first trimester and sets the monitoring strategy for this type of twins. The diagnosis of TTTS is made by ultrasound with the findings of polyhydramnios due to volume overload and polyuria in one twin and oligohydramnios due to oliguria of the co-twin. Assessment of bladder filling as well as arterial and venous Doppler patterns are required for staging disease severity. Assessment of fetal cardiac function also provides additional insight into the fetal cardiovascular impacts of the disease as well as help identify fetuses that may require postnatal follow up. Fetoscopic laser ablation of the communicating vascular anastomoses between the twins is the standard treatment for TTTS. It aims to cure the condition by interrupting the link between their circulations and making them independent of one another. Contemporary outcome data after laser surgery suggests survival for both fetuses can be anticipated in up to 65% of cases and survival of a single fetus in up to 88% of cases. However, preterm birth remains a significant contributor to postnatal morbidity and mortality. Long term outcomes of TTTS survivors indicate that up to 11% of children may show signs of neurologic impairment. Strategies to minimize preterm birth after treatment and standardized reporting by laser centers are important considerations to improve overall outcomes and understand the long-term impacts of TTTS.
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Affiliation(s)
- Jena L Miller
- The Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
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Miyoshi T, Hosoda H, Minamino N. Significance of Atrial and Brain Natriuretic Peptide Measurements in Fetuses With Heart Failure. Front Physiol 2021; 12:654356. [PMID: 33815155 PMCID: PMC8012666 DOI: 10.3389/fphys.2021.654356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/02/2021] [Indexed: 11/13/2022] Open
Abstract
Fetal heart failure is mainly caused by congenital heart defect and arrhythmia. It is difficult to appropriately diagnose the severity of fetal heart failure simply by ultrasonography because the development of a fetal heart in fetoplacental circulation and how well the fetal myocardium can adapt to postnatal cardiopulmonary circulation are challenging to assess. In adult cardiology, natriuretic peptides (NPs) are the most useful biomarker of heart failure; however, studies investigating NP levels in the fetuses and amniotic fluid are quite limited. Furthermore, little is known about their production and metabolism. This review summarized the most relevant findings on NP levels in the umbilical cord blood and amniotic fluid. The findings can then extend their use as a diagnostic biomarker of heart failure in fetuses with congenital heart defect and/or arrhythmia.
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Affiliation(s)
- Takekazu Miyoshi
- Department of Regenerative Medicine and Tissue Engineering, National Cerebral and Cardiovascular Center, Suita, Japan.,Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroshi Hosoda
- Department of Regenerative Medicine and Tissue Engineering, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Naoto Minamino
- Omics Research Center, National Cerebral and Cardiovascular Center, Suita, Japan
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Yu L, Zhou Q, Peng Q, Zeng S, Yang Z. Velocity vector imaging echocardiography and NT-proBNP study of fetal cardiac function in pregnancy-induced maternal hypertension. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:285-291. [PMID: 30883813 DOI: 10.1002/jcu.22720] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/03/2019] [Accepted: 02/17/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE To investigate whether acute and transient pressure overload in patients with pregnancy-induced hypertension affects cardiac function in fetuses. METHODS We enrolled 104 singleton pregnant women with gestational ages ranging 30 to 33 weeks, visiting for prenatal care. Among them, 34 had gestational hypertension (GH), 32 had preeclampsia (PE), and 38 were healthy and formed the control group. Conventional echocardiographic and velocity vector imaging (VVI) variables were prospectively collected. Blood levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured from cord blood drawn at birth. RESULTS The fetuses of mothers with preeclampsia had significantly lower left (LV) and right ventricle (RV) diastolic strain rate (SRd) and RV strain (S) and systolic strain rate (SRs) than controls. LV and RV S, SRd, and SRS were not different in fetuses of mothers with GH and controls. The NT-proBNP levels were higher in fetuses of patients with PE than in GH and controls. CONCLUSIONS In the third trimester of pregnancy, fetal biventricular function and NT-proBNP levels are not significantly influenced by GH. Fetuses of mothers with PE present signs of LV and RV diastolic dysfunction, right ventricular systolic dysfunction, and elevated NT-pro-BNP levels. VVI echocardiography appears more sensitive than conventional echocardiography to evaluate fetal cardiac function.
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MESH Headings
- Adult
- Biomarkers/blood
- Case-Control Studies
- Cross-Sectional Studies
- Echocardiography/methods
- Female
- Fetal Blood/metabolism
- Fetal Heart/diagnostic imaging
- Fetal Heart/physiopathology
- Gestational Age
- Heart Ventricles/diagnostic imaging
- Humans
- Hypertension, Pregnancy-Induced/physiopathology
- Infant, Newborn
- Male
- Natriuretic Peptide, Brain/blood
- Observer Variation
- Peptide Fragments/blood
- Pregnancy
- Pregnancy Trimester, Third
- Prospective Studies
- Single-Blind Method
- Ultrasonography, Prenatal/methods
- Ventricular Dysfunction, Left/blood
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/blood
- Ventricular Dysfunction, Right/diagnosis
- Ventricular Dysfunction, Right/physiopathology
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Affiliation(s)
- Li Yu
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, China
| | - Qichang Zhou
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, China
| | - Qinghai Peng
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi Zeng
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, China
| | - Zurong Yang
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, China
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Miyoshi T, Hosoda H, Umekawa T, Asada T, Fujiwara A, Kurosaki KI, Shiraishi I, Nakai M, Nishimura K, Miyazato M, Kangawa K, Ikeda T, Yoshimatsu J, Minamino N. Amniotic Fluid Natriuretic Peptide Levels in Fetuses With Congenital Heart Defects or Arrhythmias. Circ J 2018; 82:2619-2626. [PMID: 29998930 DOI: 10.1253/circj.cj-18-0235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND We have previously demonstrated that umbilical cord plasma natriuretic peptide (NP) levels reflect the severity of heart failure (HF) in fetuses with congenital heart defects (CHD). The aim of this study was to evaluate the significance of amniotic fluid (AF) NP levels in the assessment of HF in fetuses with CHD or arrhythmia. Methods and Results: This was a prospective observational study at a tertiary pediatric cardiac center. A total of 95 singletons with CHD or arrhythmia, and 96 controls from 2012 to 2015 were analyzed. AF concentrations of atrial NP (ANP), B-type NP (BNP) and N-terminal pro-B-type NP (NT-proBNP) at birth were compared with ultrasonographic assessment of fetal HF using the cardiovascular profile (CVP) score. Multivariate analysis showed that a CVP score ≤5 and preterm birth are independently associated with high AF NT-proBNP levels. AF NT-proBNP levels of fetuses with CHD or arrhythmia inversely correlated with CVP score (P for trend <0.01). In contrast, AF concentrations of ANP and BNP were extremely low, and it was difficult to assess the degree of fetal HF based on them. CONCLUSIONS AF NT-proBNP concentrations increase in stepwise fashion with the severity of HF in fetuses with CHD or arrhythmia; it was the optimal NP for assessing the fetal HF.
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Affiliation(s)
- Takekazu Miyoshi
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center.,Department of Obstetrics and Gynecology, Mie University
| | - Hiroshi Hosoda
- Department of Regenerative Medicine and Tissue Engineering, National Cerebral and Cardiovascular Center
| | | | - Takashi Asada
- Laboratory of Clinical Chemistry, National Cerebral and Cardiovascular Center
| | - Akihiro Fujiwara
- Laboratory of Clinical Chemistry, National Cerebral and Cardiovascular Center
| | - Ken-Ichi Kurosaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Isao Shiraishi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Michikazu Nakai
- Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
| | - Kunihiro Nishimura
- Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
| | - Mikiya Miyazato
- Department of Biochemistry, National Cerebral and Cardiovascular Center
| | - Kenji Kangawa
- Department of Biochemistry, National Cerebral and Cardiovascular Center
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University
| | - Jun Yoshimatsu
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Naoto Minamino
- Omics Research Center, National Cerebral and Cardiovascular Center
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Donepudi R, Mann LK, Wohlmuth C, Johnson A, Bebbington MW, Moise KJ, Boudreaux DS, Gardiner H, Papanna R. Recipient umbilical artery elongation (redundancy) in twin-twin transfusion syndrome. Am J Obstet Gynecol 2017; 217:206.e1-206.e11. [PMID: 28455084 DOI: 10.1016/j.ajog.2017.04.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/04/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Chronic hypertension in adults causes arterial lengthening in major arteries, but the effects of early fetal hypertension on the twin-twin transfusion syndrome recipient's vascular architecture remains unknown. OBJECTIVE We hypothesize that arterial cord redundancy is related to recipient hypertension and subsequent heart failure. Our objectives were to: (1) establish a 3-dimensional color Doppler ultrasound method of measuring umbilical arterial length relative to its corresponding venous segment in the umbilical cord using artery vein angle; (2) compare recipient artery vein angle to gestational age-matched controls; and (3) test the association of artery vein angle with recipient heart failure. STUDY DESIGN We compared 3 groups prospectively: twin-twin transfusion syndrome pregnancies undergoing fetoscopic laser surgery (preoperatively) and 2 groups of gestational age-matched controls: uncomplicated monochorionic-diamniotic twin pregnancies and healthy singletons. Using a 3-dimensional color-Doppler volume image of 5 cm of cord near the placental insertion, we traced the umbilical artery and vein producing umbilical artery:vein length, (artery vein index) and measured the artery vein angle between umbilical artery and vein. Correlation of artery vein angle to twin-twin transfusion syndrome stage, maximum vertical pocket, umbilical arterial indices, ductus venosus Doppler, and brain natriuretic peptide were performed. We used pulsed-wave and tissue Doppler to measure tissue Doppler velocities and indexed cardiac output and correlated these with artery vein angle. Comparative statistics, including multivariable linear regression, examined the relationship between umbilical arterial Doppler indices and artery vein angle. RESULTS Artery vein angle and artery vein index correlated significantly (R2, 0.86; P < .0001), hence, artery vein angle was used for analysis. Mean artery vein angle was 33.1 ± 31.5 degrees in recipients (n = 44), 9.5 ± 6 degrees in monochorionic-diamniotic (n = 11; 22 fetuses), and 8.9 ± 8.3 degrees in singleton controls (n = 16) (P < .001). An artery vein angle ≥26 degrees (>95th percentile for controls) was measured in 52% recipients. Artery vein angle was higher in twin-twin transfusion syndrome stage 3R vs 1 (P = .001). Artery vein angle increased with increasing umbilical arterial pulsatility index (P < .001), and decreased with increasing resistance index (P = .02) after adjusting for gestational age. Interrater agreements to categorize abnormal artery vein angle values was 95% (P < .001). Abnormal ductus venosus Doppler and elevated recipient amniotic fluid N-terminal pro-brain natriuretic peptide/protein levels correlated significantly with artery vein angle. Abnormal artery vein angles were associated with decreased indexed cardiac output, lower tissue Doppler velocities, higher right-sided Tei indices, and severe tricuspid regurgitation. CONCLUSION Umbilical arterial lengthening occurs in 52% of recipients and is associated with abnormal Doppler flows, low systolic tissue Doppler velocities, reduced cardiac output, and elevated markers of cardiac failure. This may reflect chronicity and severity of hypertension in the recipient fetus. Further research is needed to explore the mechanisms of elongation and long-term implications.
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N-terminal pro-B-type natriuretic peptide in amniotic fluid of fetuses with known or suspected cardiac load. PLoS One 2017; 12:e0177253. [PMID: 28545116 PMCID: PMC5436674 DOI: 10.1371/journal.pone.0177253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 04/25/2017] [Indexed: 12/14/2022] Open
Abstract
Background Myocardial 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. Methods Ultrasound, 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. Results Specimen 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). Conclusion Amniotic 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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Normal amino-terminal pro-brain natriuretic peptide (NT-proBNP) values in amniotic fluid. Clin Biochem 2016; 50:23-26. [PMID: 27614219 DOI: 10.1016/j.clinbiochem.2016.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/05/2016] [Accepted: 09/06/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Brain natriuretic peptide (BNP) is synthesized by human fetal membranes, both the amnion and chorion. This locally produced BNP inhibits the contraction of the human myometrium, contributing to the maintenance of myometrial quiescence during pregnancy. Reference values for NT-proBNP concentrations in amniotic fluid at different gestational ages have not been completely defined. We aimed to investigate the range of fetal NT-proBNP values in amniotic fluid in normal pregnancy between 17 and 41weeks of gestation. METHODS Samples of amniotic fluid were obtained from women meeting the following inclusion criteria: gestational age defined by early ultrasound, singleton gestation and not in labor. The exclusion criteria were as follows: multiple gestation, clinically evident chorioamnionitis, laboratory signs of infection in the amniotic fluid sample and fetal conditions that may alter NT Pro-BNP levels (anemia, hydrops, etc.). NT-proBNP concentrations in amniotic fluid were measured using the automated Elecsys® proBNP assay. RESULTS We analyzed 218 samples of amniotic fluid at various gestational ages. Half of the samples were obtained by amniocentesis (118 samples), and the other half (100 samples) were obtained by direct puncture at the time of cesarean section. We found a significant decline in NT-proBNP concentrations with advancing gestational age. DISCUSSION Gestational age has to be taken into consideration in the assessment of NT-proBNP values. Our data may be used as reference values in fetal medicine, as a possible predictor of preterm delivery risk using the inferior limit (0.5 multiples of the median (MoM)) of our normal curve.
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Abstract
This review addresses the physiology of monochorionic diamniotic (MC/DA) twins and the potential for twin–twin transfusion syndrome (TTTS). It focuses on the underlying cardiovascular pathophysiology of TTTS and the cardiovascular impact of TTTS for both the recipient and the donor twin. It explains the principles for assessment and monitoring of these cardiovascular changes and how these may be used to guide pregnancy management. Finally, it describes the effect of treatment on the altered hemodynamics and how this can influence pregnancy and perinatal management, as well as longer-term follow-up.
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Saxena A, Izmirly PM, Han SW, Briassouli P, Rivera TL, Zhong H, Friedman DM, Clancy RM, Buyon JP. Serum Biomarkers of Inflammation, Fibrosis, and Cardiac Function in Facilitating Diagnosis, Prognosis, and Treatment of Anti-SSA/Ro-Associated Cardiac Neonatal Lupus. J Am Coll Cardiol 2015; 66:930-9. [PMID: 26293764 DOI: 10.1016/j.jacc.2015.06.1088] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 06/11/2015] [Accepted: 06/15/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cardiac manifestations of neonatal lupus (cardiac NL) include congenital heart block and cardiomyopathy. Several candidate biomarkers were evaluated in cases at risk for cardiac NL on the basis of potential roles in inflammation, fibrosis, and cardiac dysfunction: C-reactive protein (CRP); NT-pro-B-type natriuretic peptide (NT-proBNP); troponin I; matrix metalloproteinase (MMP)-2; urokinase plasminogen activator (uPA); urokinase plasminogen activator receptor (uPAR); plasminogen; and vitamin D. OBJECTIVES Identification of maternal and fetal biomarkers associated with development and morbidity of cardiac NL should provide clues to pathogenesis with translational implications for management. METHODS Cord (139) and maternal (135) blood samples collected during pregnancies at risk for cardiac NL were available for study. Levels of cord and maternal CRP, cord NT-proBNP, and cord troponin I were evaluated using multiplex assays. Cord and maternal vitamin D were assessed by liquid chromatography-mass spectrometry. MMP-2, uPA, uPAR, and plasminogen were evaluated using ELISA. RESULTS Cord CRP, NT-proBNP, MMP-2, uPA, uPAR, and plasminogen levels were higher in cardiac NL-affected fetuses than in unaffected cases, independent of maternal rheumatic disease, season at highest risk of cardiac NL development, and medications taken during pregnancy. These biomarkers were positively associated with a disease severity score derived from known risk factors for mortality in cardiac NL. Maternal CRP and cord troponin I levels did not differ between the groups. Cord and maternal vitamin D levels were not significantly associated with cardiac NL, but average maternal vitamin D level during pregnancy was positively associated with longer time to postnatal pacemaker placement. CONCLUSIONS These data support the association of fetal reactive inflammatory and fibrotic components with development and morbidity of cardiac NL. Following CRP and NT-proBNP levels after birth can potentially monitor severity and progression of cardiac NL. MMP-2 and the uPA/uPAR/plasminogen cascade provide therapeutic targets to decrease fibrosis. Although decreased vitamin D did not confer increased risk, given the positive influence on postnatal outcomes, maternal levels should be optimized.
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Affiliation(s)
- Amit Saxena
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, New York.
| | - Peter M Izmirly
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Sung Won Han
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Paraskevi Briassouli
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Tania L Rivera
- Division of Rheumatology, Department of Medicine, Scripps Memorial Hospital, La Jolla, San Diego, California
| | - Hua Zhong
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Deborah M Friedman
- Division of Pediatric Cardiology, New York Medical College, Valhalla, New York
| | - Robert M Clancy
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, New York
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Merz WM, Leufgen C, Fimmers R, Stoffel-Wagner B, Gembruch U. Reference intervals for N-terminal pro-B-type natriuretic peptide in amniotic fluid between 10 and 34 weeks of gestation. PLoS One 2014; 9:e114416. [PMID: 25490554 PMCID: PMC4260852 DOI: 10.1371/journal.pone.0114416] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 11/10/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In adult and pediatric cardiology, n-terminal pro-B-type natriuretic peptide (nt-proBNP) serves as biomarker in the diagnosis and management of cardiovascular dysfunction. Elevated levels of circulating nt-proBNP are present in fetal conditions associated with myocardial pressure or volume load. Compared to fetal blood sampling, amniocentesis is technically easier and can be performed from early pregnancy onwards. We aimed to investigate amniotic fluid (AF) nt-proBNP concentrations in normal pregnancies between 10 and 34 weeks of gestation. METHODS Nt-proBNP and total protein (TP) was measured in AF by chemiluminescence assay (photometry, respectively). To adjust for a potential dilutional effect, the AF-nt-proBNP/AF-TP ratio was analyzed. Reference intervals were constructed by regression modeling across gestational age. RESULTS 132 samples were analyzed. A negative correlation between AF-nt-proBNP/AF-TP ratio and gestational age was observed. Curves for the mean and the 5% and 95% reference interval between 10 and 34 weeks of gestation were established. CONCLUSION In normal pregnancy, nt-proBNP is present in AF and decreases during gestation. Our data provide the basis for research on AF-nt-proBNP as biomarker in fetal medicine.
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Affiliation(s)
- Waltraut M. Merz
- Department of Obstetrics and Prenatal Medicine, University Bonn Medical School, Bonn, Germany
| | - Christina Leufgen
- Department of Obstetrics and Prenatal Medicine, University Bonn Medical School, Bonn, Germany
| | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University Bonn Medical School, Bonn, Germany
| | - Birgit Stoffel-Wagner
- Institute for Clinical Chemistry and Pharmacology, University Bonn Medical School, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Bonn Medical School, Bonn, Germany
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Merz WM, Gembruch U. Old tool - new application: NT-proBNP in fetal medicine. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:377-385. [PMID: 24919683 DOI: 10.1002/uog.13443] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 05/29/2014] [Accepted: 06/05/2014] [Indexed: 06/03/2023]
Affiliation(s)
- W M Merz
- Department of Obstetrics and Prenatal Medicine, University Bonn Medical School, Bonn, Germany
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Fan X, Zhou Q, Zeng S, Zhou J, Peng Q, Zhang M, Ding Y. Impaired fetal myocardial deformation in intrahepatic cholestasis of pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1171-1177. [PMID: 24958403 DOI: 10.7863/ultra.33.7.1171] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To investigate changes in fetal myocardial deformation in intrahepatic cholestasis of pregnancy. METHODS Patients with intrahepatic cholestasis of pregnancy were divided into 2 groups according to the total maternal serum bile acid concentration: mild cholestasis (10-40 μmol/L) and severe cholestasis (>40 μmol/L). Fetal echocardiography and velocity vector imaging were performed on women with cholestasis and control patients. The left ventricular global longitudinal strain and strain rate were measured. Clinical characteristics, maternal serum bile acid levels, and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in umbilical vein blood were compared between groups. The relationships among fetal myocardial deformation, maternal total bile acids, and cord NT-proBNP were analyzed. RESULTS Twenty women with mild cholestasis, 20 with severe cholestasis, and 40 control patients were enrolled. There were no significant differences in maternal and gestational ages between the case and control groups. Maternal bile acids and NT-proBNP were significantly higher in fetuses of mothers with cholestasis than control fetuses. The left ventricular longitudinal strain (-10.56% ± 1.83% versus -18.36% ± 1.11%; P < .01), systolic strain rate (-1.63 ± 0.18 versus -2.04 ± 0.18 secondsz(-1); P < .01), and diastolic strain rate (1.37 ± 0.18 versus 1.83 ± 0.14 seconds(-1); P < .01) were significantly decreased in fetuses with severe cholestasis compared with control fetuses. There were positive correlations between fetal myocardial deformation and maternal total bile acids (r = 0.705, 0.643, and 0.690, respectively; P < .01) and between myocardial deformation and NT-proBNP (r = 0.672, 0.643, and 0.647; P < .01). CONCLUSIONS Fetal myocardial deformation is impaired in severe intrahepatic cholestasis of pregnancy. Further investigation is needed to determine whether fetal echocardiography and velocity vector imaging can help predict which fetuses of mothers with cholestasis are likely to have poor outcomes.
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Affiliation(s)
- Xuemei Fan
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China
| | - Qichang Zhou
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China.
| | - Shi Zeng
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China
| | - Jiawei Zhou
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China
| | - Qinghai Peng
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China
| | - Ming Zhang
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China
| | - Yiling Ding
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China
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N-terminal pro-brain natriuretic peptide levels in monochorionic diamniotic twins with selective intrauterine growth restriction. J Perinatol 2014; 34:6-10. [PMID: 24071906 DOI: 10.1038/jp.2013.119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/16/2013] [Accepted: 08/19/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare serum N-terminal pro-brain natriuretic peptide levels at birth between monochorionic diamniotic twins with and without selective intrauterine growth restriction. STUDY DESIGN Blood samples were collected from 73 monochorionic diamniotic twins without twin-to-twin transfusion syndrome. Two groups were studied on the basis of fetal ultrasonographic findings: 16 twins with and 57 twins without selective intrauterine growth restriction. Selective intrauterine growth restriction was defined as an estimated fetal weight below the 10th percentile in one twin at 18 to 26 weeks of gestation. Serum N-terminal pro-brain natriuretic peptide levels were measured. RESULT Serum N-terminal pro-brain natriuretic peptide levels in monochorionic diamniotic twins with selective intrauterine growth restriction were significantly higher than in those without selective intrauterine growth restriction. Selective intrauterine growth restriction was independently associated with increased N-terminal pro-brain natriuretic peptide levels. CONCLUSION N-terminal pro-brain natriuretic peptide levels at birth are elevated in monochorionic diamniotic twins with selective intrauterine growth restriction.
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Hui L, Wick HC, Moise KJ, Johnson A, Luks F, Haeri S, Johnson KL, Bianchi DW. Global gene expression analysis of amniotic fluid cell-free RNA from recipient twins with twin-twin transfusion syndrome. Prenat Diagn 2013; 33:873-83. [PMID: 23640821 DOI: 10.1002/pd.4150] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 04/23/2013] [Accepted: 04/25/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of this study was to understand the biological pathways involved in twin-twin transfusion syndrome (TTTS) by performing global gene expression analysis of amniotic fluid (AF) cell-free RNA. METHODS A prospective whole transcriptome microarray study analyzing cell-free RNA in AF from TTTS recipient twins and singleton controls was carried out. Significantly differentially regulated genes in TTTS cases (N = 8) versus matched controls (N = 8) were identified and pathways analyses performed. Significant gene expression differences between stage II TTTS recipients (N = 5) and stage III TTTS recipients with abnormal Doppler measurements (N = 5) were also analyzed. RESULTS Analysis of paired data from TTTS cases and controls revealed differential expression of 801 genes, which were significantly enriched for neurological disease and cardiovascular system pathways. We also identified cardiovascular genes and pathways associated with the presence of critically abnormal Doppler measurements in stage III TTTS recipients. CONCLUSIONS This study provides the first transcriptome-wide data on the impact of TTTS on fetal development. Our results show that gene expression involving neurological and cardiovascular pathways are altered in recipient fetuses prior to surgical treatment. This has relevance for the origins of long-term complications seen in survivors and for the development of future fetal biomarkers.
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Affiliation(s)
- Lisa Hui
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA, USA.
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Moriichi A, Cho K, Furuse Y, Akimoto T, Kaneshi Y, Yamada T, Morikawa M, Yamada T, Minakami H. B-type natriuretic peptide levels are correlated with birth-weight discordance in monochorionic-diamniotic twins without twin-twin transfusion syndrome. J Perinatol 2013; 33:182-7. [PMID: 22791277 DOI: 10.1038/jp.2012.94] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine whether B-type natriuretic peptide (BNP) levels in umbilical cord blood (UCB) and amniotic fluid (AF) are correlated with birth-weight discordances in monochorionic-diamniotic twins. STUDY DESIGN The UCB-BNP and AF-BNP levels were determined at birth in 36 twin-pairs without twin-twin transfusion syndrome (TTTS). RESULT Both the UCB-BNP and the AF-BNP levels were significantly higher among twins with either a birth-weight discordance ≥20% (141.6 versus 52.9 pg ml(-1) for UCB-BNP, 38.0 versus 17.2 pg ml(-1) for AF-BNP) or cardiac dysfunction at birth (167.2 versus 56.3 pg ml(-1) for UCB-BNP, 34.9 versus 19.0 pg ml(-1) for AF-BNP), compared with neonates without the respective characteristics. The UCB-BNP and AF-BNP levels in both the larger and the smaller twins were significantly correlated with birth-weight discordance. CONCLUSION Cardiac dysfunction occurs in both larger and smaller co-twins with increasing birth-weight discordances, even in the absence of TTTS.
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Affiliation(s)
- A Moriichi
- Maternity and Perinatal Care Center, Hokkaido University Hospital, Sapporo, Japan.
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Moriichi A, Cho K, Mizushima M, Furuse Y, Akimoto T, Yamada T, Minakami H. B-type natriuretic peptide levels at birth predict cardiac dysfunction in neonates. Pediatr Int 2012; 54:89-93. [PMID: 22044425 DOI: 10.1111/j.1442-200x.2011.03500.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although the B-type natriuretic peptide (BNP) levels in the umbilical cord blood (UCB-BNP) and amniotic fluid (AF-BNP) of neonates may be clinically useful for identifying newborns with cardiac dysfunction, the effects of various clinical factors, such as gestational age at birth, small for gestational age (SGA), and neonatal asphyxia, on the UCB-BNP and AF-BNP levels have not been studied extensively. METHODS The present study sought to determine whether the UCB-BNP and AF-BNP levels can predict cardiac dysfunction and hypotension in preterm infants soon after birth and to evaluate the association between BNP and various clinical factors. The UCB-BNP and AF-BNP levels at birth were determined in 320 and 195 neonates, respectively, born to mothers with singleton pregnancies. RESULTS The UCB-BNP and AF-BNP levels in infants treated with dopamine were significantly higher than those in infants without dopamine administration (230.1 vs 33.1 pg/mL and 74.4 vs 18.1 pg/mL, respectively). Stepwise multiple regression analyses indicated that gestational age, SGA, asphyxia, and chorioamnionitis were significant independent determinants of the UCB-BNP level. Cut-off values of >90 pg/mL for UCB-BNP and >36 pg/mL for AF-BNP yielded sensitivities of 68% and 93%, respectively, and specificities of 84% and 81%, respectively, for detecting neonates who required dopamine administration after birth. CONCLUSION High UCB-BNP and AF-BNP levels predict neonatal cardiac dysfunction soon after birth.
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Affiliation(s)
- Akinori Moriichi
- Maternity and Perinatal Care Center, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.
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