Miyoshi T, et al. - An exploratory analysis was conducted of the importance of plasma natriuretic peptides (NPs) levels in the inspection of heart failure, among fetuses with congenital heart defect (CHD) and arrhythmia. The findings shed light on the connection between plasma NP levels in fetuses with CHD, arrhythmia, or both with the severity of fetal heart failure. Elevated NP levels were the result of increases in central venous pressure secondary to arrhythmia or atrioventricular valve regurgitation arising on account of a CHD, instead of the morphological abnormality itself.

Methods

• The plot of this trial was a prospective observational study, carried out at a tertiary pediatric cardiac center.
• The enrolled candidates included 129 singletons with CHD, arrhythmia, or both and 127 controls, examined from 2012 to 2015.
• A comparison was performed between the umbilical cord plasma atrial NP, brain NP and N-terminal pro-brain NP levels at birth with the ultrasonography findings, indicating fetal heart failure such as a cardiovascular profile (CVP) score and morphological characteristics.

Results

• Higher NP levels were displayed among fetuses with CHD, arrhythmia, or both than controls (P<0.01).
• NP levels of fetuses with CHD, arrhythmia, or both illustrated an inverse association with CVP score (P for trend <0.01).
• There were no variations in NP levels between fetuses with CHD or arrhythmia and a CVP score of ≥8 versus controls.
• A CVP score of ≤5, tachy- or bradyarrhythmia at birth, preterm birth, and umbilical artery pH <7.15 were independently related to high NP levels (P<0.01).
• Among fetuses with a CVP score of ≤7, abnormal venous Doppler sonography findings were more commonly prominent and more severe in fetuses with tachy- or bradyarrhythmia than those with CHDs.
• Fetuses with tachy- or bradyarrhythmia reported higher NP levels than those with CHDs (P=0.01).
• It was noted that fetuses with right heart defect and moderate or severe tricuspid valve regurgitation presented with considerably higher NP levels than fetuses with other types of CHD (P<0.01).