Amniotic fluid markers of fetal cardiac dysfunction in twin-to-twin transfusion syndrome.
OBJECTIVE
The objective of the study was to determine whether cardiac troponin T (cTnT) and natriuretic peptides can be isolated from the amniotic fluid (AF) of pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) and whether they correlate with fetal echocardiographic findings and recipient survival.


METHODS
AF samples from the recipient sac were obtained in 52 TTTS cases and 16 controls. Samples were assayed for cTnT and natriuretic peptides. Prior to fetoscopic laser therapy, 34 recipient twins underwent assessment of atrioventricular flow patterns, myocardial performance index (MPI), and precordial venous Dopplers. Fetal survival was assessed 48 hours postoperatively.


RESULTS
AF B-type natriuretic peptide and cTnT levels were elevated in TTTS and correlated with functional echocardiographic findings. Postoperative recipient survival was 72% when both AF-cTnT and left ventricular MPI were increased. If 1 of both markers was normal, survival was 100% (P = .046).


CONCLUSIONS
Combining ultrasound and AF-cTnT measurements allows the identification of fetuses at risk of postoperative demise.
Van Mieghem
Tim
T
Department of Obstetrics and Gynecology, University Hospitals Leuven, Belgium.
Doné
Elisa
E
Gucciardo
Léonardo
L
Klaritsch
Philipp
P
Allegaert
Karel
K
Van Bree
Rita
R
Lewi
Liesbeth
L
Deprest
Jan
J
D000328:Adult; D000653:Amniotic Fluid / Q000737:chemistry*; D009320:Atrial Natriuretic Factor / Q000032:analysis*; D015415:Biomarkers / Q000032:analysis*; D005260:Female; D005330:Fetofetal Transfusion / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000032:analysis*; D011247:Pregnancy; D011256:Pregnancy Outcome; D020107:Troponin T / Q000032:analysis*; D016216:Ultrasonography, Prenatal; D016277:Ventricular Function, Left
D015415:Biomarkers; D020107:Troponin T; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor