Objective To investigate the dynamic changes of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) during gestation period in women with heart disease, and to evaluate their predictive value for adverse pregnancy outcomes.
Methods A total of 221 pregnant women with heart disease undergoing peripartum management were enrolled and divided into adverse outcome group (n=68) and favorable outcome group (n=153) based on pregnancy outcomes. General clinical data and pregnancy outcomes were compared between two groups. Levels of NT-proBNP and hs-cTnT were measured during early pregnancy, mid-pregnancy as well as late pregnancy and within 24 hours postpartum. The predictive value of NT-proBNP and hs-cTnT for adverse pregnancy outcomes was evaluated using receiver operating characteristic (ROC) curve analysis. Multivariate Logistic regression analysis was used to screen independent risk factors for adverse pregnancy outcomes.
Results There was a statistically significant difference in the New York Heart Association (NYHA) cardiac function classification, left ventricular ejection fraction (LVEF) and pulmonary artery systolic pressure (PASP) between two groups (P < 0.001). In the early stage of pregnancy, the second stage of pregnancy, the third stage of pregnancy and at 24 hours after delivery, the levels of NT-proBNP and hs-cTnT in the adverse outcome group were higher than those in the favorable outcome group, and the differences were statistically significant (P < 0.001). The incidence of maternal complications in the adverse outcome group was higher than that in the favorable outcome group, and the difference was statistically significant (P < 0.01 or P < 0.001). The rates of preterm birth, low birth weight and neonatal asphyxia in the adverse outcome group were higher than those in the favorable outcome group, and the differences were statistically significant (P < 0.01 or P < 0.001). The ROC curve analysis showed that the area under the curve (AUC) of NT-proBNP was 0.892 (95%CI, 0.845 to 0.939), the AUC of hs-cTnT was 0.857 (95%CI, 0.802 to 0.912), and the AUC of the combined detection of the two was 0.924 (95%CI, 0.885 to 0.963). The NT-proBNP>986.5 pg/mL (OR=6.85, 95%CI, 3.24 to 14.46) and hs-cTnT>15.8 ng/L (OR=5.62, 95%CI, 3.24 to 14.46) in the third trimester 2.86 to 11.05) and NYHA class Ⅲ to Ⅳ (OR=4.28, 95%CI, 1.96 to 9.35) were independent risk factors for adverse pregnancy outcomes.
Conclusion The levels of NT-proBNP and hs-cTnT during the perinatal period in patients with pregnancy complicated with heart disease show dynamic changes. Monitoring two indicators has important clinical value for predicting adverse pregnancy outcomes.
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