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Pregnancy in a healthy population: dynamics of NTproBNP and hs-cTroponin T
  1. Eva Furenäs1,
  2. Peter Eriksson1,
  3. Ulla-Britt Wennerholm2 and
  4. Mikael Dellborg1
  1. 1Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Center for Adults with Grown Up Congenital Heart Disease (GUCH), Department of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
  2. 2Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Department of Obstetrics and Gynaecology Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden
  1. Correspondence to Dr Eva Furenäs; eva.furenas{at}vgregion.se

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 (p<0.05). Regardless, the 95th percentile for both biomarkers was below cut-off levels of 300 ng/L for NTproBNP and 14 ng/L for hs-cTNT. There was an association between NTproBNP above the upper limit of normal of 125 ng/L and eGFR (p=0.04) and between hs-cTNT >5.0 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.

  • myocardial disease
  • heart failure
  • cardiac function
  • emergency medicine
  • chest pain clinic
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2020-001293

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    Footnotes

    • Contributors All authors have contributed with design, conduct and reporting and are accountable for all aspects of the work. All authors, with EF as guarantor, take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

    • Funding The study was funded by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (grant number 236611). The study was also funded by The Swedish Heart-Lung Foundation (grant number 20150774).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was conducted according to the World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects and was approved by the Regional Ethical Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available.