What is the clinical evidence from this study?

Study design: Cohort. Population: Healthy pregnancy (n=196). Intervention: Observation of NTproBNP and hs-cTNT. Primary outcome: Intraindividual changes of NTproBNP and hs-cTNT levels and evaluation of existing cut-off levels.

October 1, 2020Open Access

Pregnancy in a healthy population: dynamics of NTproBNP and hs-cTroponin T

EFEva FurenäsSahlgrenska University Hospital PEPeter ErikssonSahlgrenska University Hospital UWUlla‐Britt WennerholmSahlgrenska University Hospital

Key Result

Existing cut-off values for ruling out heart failure (NTproBNP <300 ng/L) and myocardial ischaemia (hs-cTNT <14 ng/L) remain applicable during pregnancy and after delivery.

Study Design

Type

Cohort (n=196)

Structured PICO

Are standard cut-off levels for NTproBNP and hs-cTNT applicable for ruling out heart failure and myocardial ischemia during and after pregnancy?

Population

196 healthy pregnant women recruited from maternal outpatient clinics, with existing cardiac disease ruled out by echocardiography

Outcome

Intraindividual changes of NTproBNP and hs-cTNT levels during and after pregnancy, and evaluation of existing cut-off levelssurrogate

Standard cut-off values for ruling out heart failure (NTproBNP <300 ng/L) and myocardial ischemia (hs-cTNT <14 ng/L) remain applicable during pregnancy and after delivery in healthy women.

Abstract

OBJECTIVE: To describe the intraindividual changes of heart biomarker levels during and after pregnancy and to evaluate existing cut-off levels for heart failure or myocardial ischaemia in pregnant women. METHOD: A total of 196 healthy pregnant women were recruited from maternal outpatient clinics and included in the study. Blood samples were obtained on four occasions: at 10-12 gestational weeks (gw), 20-25 gw, after delivery and 6 months postpartum and analysed for N-terminal pro-brain natriuretic peptide (NTproBNP) and high sensitive cardiac troponin T (hs-cTNT). Echocardiography ruled out existing cardiac disease. Estimated glomerular filtration rate (eGFR) was calculated. RESULTS: There were significant changes in NTproBNP between the measurements with the highest NTproBNP at 10-12 gw and the lowest value being at 20-25 gw, (with eGFR being the highest). Hs-cTNT was significantly higher at the peripartum measurement compared with the other measurements (p5.0 ng/L and time from delivery to blood sample (p=0.001) at the peripartum measurement. Both were associated with the use of oxytocin. CONCLUSION: Existing cut-off values for ruling out heart failure (NTproBNP <300 ng/L) and myocardial ischaemia (hs-cTNT <14 ng/L) are applicable during pregnancy and after delivery. Elevated levels mandate further attention on cardiac symptoms and renal function.

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