Cardiac function impairment in recipient twins of twin-to-twin transfusion syndrome: Insights from NT-proBNP levels in amniotic fluid.

OBJECTIVES

To investigate changes in N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in the amniotic fluid of recipient twins with twin-twin transfusion syndrome (TTTS), analyze the correlation between NT-proBNP and cardiac linear measurements, and assess the feasibility of NT-proBNP as a biochemical marker for fetal cardiac function.

DESIGN AND

METHODS

A total of 47 pregnancies with TTTS, 21 idiopathic polyhydramnios pregnancies, and 114 normal singleton pregnancies were included from Xiangya Hospital of Central South University between October 2020 and July 2023. Fetal cardiac linear parameters, amniotic fluid depth, and NT-proBNP levels in amniotic fluid were measured across the three groups. The correlation of NT-proBNP with amniotic fluid depth, cardiac linear parameters, and CHOP score in TTTS recipients was analyzed.

RESULTS

There was no statistically significant difference in amniotic fluid NT-proBNP levels and cardiac linear parameters between idiopathic polyhydramnios and normal singletons. However, NT-proBNP levels and cardiac parameters in TTTS recipient twins were significantly higher than in the other two groups (p < 0.05). After adjusting for gestational variables, NT-proBNP levels in TTTS recipients showed significant correlations with atrial and ventricular diameters, ventricular wall thickness, cardiothoracic ratio, and CHOP score.

CONCLUSIONS

Amniotic fluid NT-proBNP is a sensitive and objective biochemical marker for assessing fetal cardiac function, independent of amniotic fluid volume. It serves as a valuable complement to echocardiographic assessment in evaluating the severity of fetal heart failure in TTTS recipients.