Cardiovascular hemodynamics and umbilical artery N-terminal peptide of proB-type natriuretic peptide in human fetuses with growth restriction

A. Girsen, M. Ala-Kopsala, K. Mäkikallio, O. Vuolteenaho, Juha Rasanen

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

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 7115 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.

Original languageEnglish (US)
Pages (from-to)296-303
Number of pages8
JournalUltrasound in Obstetrics and Gynecology
Volume29
Issue number3
DOIs
StatePublished - Mar 2007
Externally publishedYes

Fingerprint

Natriuretic Peptides
Umbilical Arteries
hemodynamics
fetuses
arteries
peptides
constrictions
Fetus
Hemodynamics
Peptides
Growth
Rheology
veins
Hepatic Veins
delivery
Veins
blood
Control Groups
cardiac output
Inferior Vena Cava

Keywords

  • Fetal echocardiography
  • Heart failure
  • Natriuretic peptides
  • Physiology

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Reproductive Medicine
  • Acoustics and Ultrasonics

Cite this

Cardiovascular hemodynamics and umbilical artery N-terminal peptide of proB-type natriuretic peptide in human fetuses with growth restriction. / Girsen, A.; Ala-Kopsala, M.; Mäkikallio, K.; Vuolteenaho, O.; Rasanen, Juha.

In: Ultrasound in Obstetrics and Gynecology, Vol. 29, No. 3, 03.2007, p. 296-303.

Research output: Contribution to journalArticle

Girsen, A. ; Ala-Kopsala, M. ; Mäkikallio, K. ; Vuolteenaho, O. ; Rasanen, Juha. / Cardiovascular hemodynamics and umbilical artery N-terminal peptide of proB-type natriuretic peptide in human fetuses with growth restriction. In: Ultrasound in Obstetrics and Gynecology. 2007 ; Vol. 29, No. 3. pp. 296-303.
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T1 - Cardiovascular hemodynamics and umbilical artery N-terminal peptide of proB-type natriuretic peptide in human fetuses with growth restriction

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AU - Ala-Kopsala, M.

AU - Mäkikallio, K.

AU - Vuolteenaho, O.

AU - Rasanen, Juha

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AB - 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 7115 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.

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KW - Heart failure

KW - Natriuretic peptides

KW - Physiology

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