The relationship between amniotic fluid levels of brain-type natriuretic peptide and recipient cardiomyopathy in twin-twin transfusion syndrome.
OBJECTIVE
We sought to evaluate amniotic fluid brain natriuretic peptide (BNP) levels as a biomarker of recipient twin (RT) cardiomyopathy (RTCM) in twin-twin transfusion syndrome.


METHODS
Amniotic fluid samples were obtained from 157 twin-twin transfusion syndrome RTs and from 6 singletons (controls) from 2007 through 2009. N-terminal prohormone BNP (NT-proBNP) levels were quantified by enzyme-linked immunosorbent assay. RTCM was classified as mild (IIIA), moderate (IIIB), or severe (IIIC) by fetal echocardiography. The relationship between NT-proBNP and RTCM was evaluated using analysis of variance. The ability of NT-proBNP to predict moderate or greater RTCM was evaluated by receiver operating characteristic analysis.


RESULTS
There is a significant positive correlation between NT-proBNP levels and worsening RTCM (r = 0.33; P < .001). NT-proBNP thresholds of 569 fmol/mg and 369 fmol/mg had a sensitivity of 70% and 87%, and specificity of 67% and 42%, respectively, in predicting moderate or greater RTCM.


CONCLUSIONS
This is the first large case series that demonstrates a relationship between NT-proBNP and RTCM. This pathophysiologic insight supports ongoing efforts to develop screening biomarkers.
Habli
Mounira
M
Fetal Care Center of Cincinnati, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA.
Cnota
James
J
Michelfelder
Erik
E
Salisbury
Shelia
S
Schnell
Beverly
B
Polzin
William
W
Lim
Foong Yen
FY
Crombleholme
Timothy M
TM
D000328:Adult; D000653:Amniotic Fluid / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism; D001783:Blood Flow Velocity; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000378:metabolism*; D016022:Case-Control Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005330:Fetofetal Transfusion / Q000378:metabolism*; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D010446:Peptide Fragments / Q000378:metabolism*; D011247:Pregnancy; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler; D014471:Umbilical Veins / Q000000981:diagnostic imaging
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain