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Cardiovascular hemodynamics and umbilical artery N‐terminal peptide of proB‐type natriuretic peptide in human fetuses with growth restriction
Author(s) -
Girsen A.,
AlaKopsala M.,
Mäkikallio K.,
Vuolteenaho O.,
Räsänen J.
Publication year - 2007
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.3934
Subject(s) - ductus venosus , medicine , fetus , umbilical artery , cardiology , natriuretic peptide , hemodynamics , umbilical vein , inferior vena cava , intrauterine growth restriction , pregnancy , heart failure , biochemistry , genetics , chemistry , in vitro , biology
Objective To test our hypothesis that human fetal N‐terminal peptide of proB‐type natriuretic peptide (NT‐proBNP) secretion is increased in proportion to the severity of fetal cardiovascular compromise in intrauterine growth restriction. Methods This prospective cross‐sectional study consisted of 42 growth‐restricted fetuses who underwent Doppler ultrasonographic examination of cardiovascular hemodynamics within 7 days before delivery. Group 1 fetuses ( n = 13) had normal umbilical artery (UA) velocimetry. Group 2 fetuses ( n = 15) had abnormal UA and normal ductus venosus (DV) velocimetry. In Group 3 fetuses ( n = 14), both UA and DV velocimetries were abnormal. At delivery, an UA blood sample was obtained for assessment of NT‐proBNP. Normal values for UA NT‐proBNP were determined in 49 neonates (control group) with uncomplicated pregnancy and delivery. Results Group 3 fetuses demonstrated greater ( P < 0.05) UA and descending aorta pulsatility indices (PIs) and greater DV, left hepatic vein (LHV) and inferior vena cava PIs for veins (PIVs) than fetuses in Groups 1 and 2. Weight‐indexed cardiac outputs and ventricular ejection forces were similar among the groups. Group 3 fetuses had higher ( P < 0.05) UA NT‐proBNP concentration than fetuses in Groups 1 and 2. In the control group, the 95 th percentile value of UA NT‐proBNP was 518 pmol/L. In Group 3, 13/14 neonates demonstrated abnormal UA NT‐proBNP levels. The corresponding incidences were 4/13 and 7/15 in Groups 1 and 2. Significant positive correlations were found between UA, DV and LHV PIVs and UA NT‐proBNP concentrations. Conclusion In human fetal growth restriction, increased cardiac afterload and pulsatility in DV blood velocity waveform pattern are associated with elevated UA NT‐proBNP concentrations. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.