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Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in the first trimester are associated with adverse cardiovascular complications and a decline in subpulmonary ventricular function later in pregnancy in women with congenital heart disease (CHD).
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NT-proBNP levels remain high throughout pregnancy in women with CHD developing cardiovascular complications.
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NT-proBNP levels decrease steadily from the second trimester onwards in women with CHD who do not develop cardiovascular complications.
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First-trimester NT-proBNP evaluation is useful for tailored care in pregnant women with CHD.
Introduction
Methods
Study design
Pregnancy follow-up and CV complications
Statistical analysis
Results
Baseline characteristics
n = 126 | |
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Primary CHD | |
Left-sided lesions | 41 (32.5) |
– Repaired aortic coarctation | 18 (14.3) |
– Aortic valve stenosis/bicuspid aortic valve | 18 (14.3) |
– Mitral valve disease | 5 (4.0) |
Right-sided lesions | 34 (27.0) |
– Double-chambered right ventricle | 1 (0.8) |
– Ebstein’s anomaly | 5 (4.0) |
– Pulmonary atresia | 1 (0.8) |
– Pulmonary valve stenosis | 14 (11.1) |
– Tetralogy of Fallot | 13 (10.3) |
Shunt lesions | 36 (28.6) |
– Abnormal pulmonary venous return | 1 (0.8) |
– Atrial septal defect | 10 (7.9) |
– Atrioventricular septal defect | 7 (5.6) |
– Ventricular septal defect | 18 (14.3) |
Connective tissue disorder | 3 (2.4) |
Right aortic arch | 1 (0.8) |
Complex CHD | 11 (8.7) |
– Fontan circulation | 1 (0.8) |
– Transposition of great arteries (Mustard/Senning correction) | 3 (2.4) |
– Transposition of great arteries (arterial switch correction) | 3 (2.4) |
– Congenitally corrected transposition of great arteries | 2 (1.6) |
– Right ventricular hypoplasia with pulmonary valve stenosis and bilateral Glenn procedure | 1 (0.8) |
– Truncus arteriosus | 1 (0.8) |
NYHA class | |
– I | 111 (88.1) |
– II | 9 (7.1) |
Modified WHO classa | |
– I | 16 (12.7) |
– II | 87 (69.0) |
– III | 23 (18.3) |
Mechanical valve prosthesis | 7 (5.6) |
Prior cardiac event (HF, TIA, stroke, arrhythmia) | 19 (15.1) |
Hypertension before pregnancy | 5 (6.1) |
Pacemaker | 2 (1.6) |
Cardiac medication use prior to pregnancya | 28 (30.1) |
– Beta-blocker | 21 (22.6) |
– Other | 13 (14.0) |
Echocardiographic parametersa,b | |
Systemic AV valve regurgitationc | 3 (3.7) |
Pulmonary AV valve regurgitationc | 6 (7.3) |
Pulmonary stenosisd | 5 (6.1) |
Pulmonary valve regurgitationc | 12 (14.6) |
Aortic valve stenosisd | 7 (8.5) |
Aortic valve regurgitationc | 2 (2.4) |
Systemic ventricular systolic dysfunctione | 3 (3.7) |
Systemic ventricular hypertrophyf | 6 (7.3) |
Subpulmonary ventricular systolic dysfunctiong | 17 (20.7) |
CV complications and first-trimester NT-proBNP
Variables | OR | 95% CI | p-value |
---|---|---|---|
Univariable predictor | |||
Maternal age at conception | 0.9 | 0.8–1.1 | 0.401 |
WHO class III or IV | 14.0 | 2.5–77.9 | 0.003 |
Parity | 0.4 | 0.1–2.0 | 0.243 |
Smokinga | 2.7 | 0.3–27.6 | 0.407 |
Resting heart ratea | 1.0 | 0.9–1.1 | 0.979 |
Sinus rhythma | 0.4 | 0.1–1.7 | 0.202 |
Use of cardiac medicationa | 3.2 | 0.7–15.4 | 0.140 |
TabelPrior cardiac event | 4.8 | 1.0–23.6 | 0.052 |
History of arrhythmia | 5.2 | 1.1–25.5 | 0.042 |
Mechanical valve prosthesis | 9.1 | 1.4–59.1 | 0.020 |
Right systemic ventricle | 15.5 | 2.1–114.4 | 0.007 |
Aortic valve stenosisa | 5.6 | 0.9–36.5 | 0.072 |
Pulmonary valve stenosisa | 2.9 | 0.3–30.4 | 0.371 |
Aortic valve regurgitationa | −18.8 | 0–0 | 0.999 |
Pulmonary valve regurgitationa | −19.0 | 0–0 | 0.999 |
LVEFa | 1.0 | 0.9–1.2 | 0.780 |
TAPSEa | 0.8 | 0.7–1.0 | 0.100 |
Subpulmonary ventricular dysfunction (TAPSE < 17 mm)a | 4.9 | 0.6–37.7 | 0.124 |
Elevated NT-proBNP in first trimesterb | 10.9 | 2.2–54.1 | 0.004 |
Cardiac function and first-trimester NT-proBNP
n | Beta | 95% CI | p-value | |
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Age | 126 | 0.044 | 0.013–0.075 | 0.005 |
NYHA class | 126 | 0.379 | 0.041–0.718 | 0.028 |
LVEDD/BSA | 99 | 0.044 | −0.008–0.096 | 0.100 |
LVESD/BSA | 92 | 0.033 | −0.016–0.083 | 0.187 |
LAVi | 50 | 0.023 | −0.010–0.055 | 0.163 |
LVEF | 103 | −0.037 | −0.059–−0.016 | 0.001 |
TAPSEa | 104 | −0.054 | −0.080–−0.029 | <0.001 |
S’ RVa | 74 | −0.059 | −0.113–−0.005 | 0.034 |
E/A ratio | 86 | 0.286 | −0.069–0.641 | 0.113 |
E’ | 75 | 0.021 | −0.042–0.084 | 0.515 |
Multivariable regression analysesa,b | ||||
Age | 126 | 0.054 | 0.018–0.089 | 0.004 |
TAPSE | 104 | −0.060 | −0.087–−0.033 | <0.001 |