Study On 109 Cases Of Pregnancy Complicated With Heart Disease And The Clinical Value Of Initial NT-proBNP Test

Objective:To learn about the type distribution of the pregnancy patients complicated with heart disease accepted by the emergency department in the Second Hospital of Hebei Medical University,and then to explore the theoretical value of initial NT-pro BNP test in the cardiac function evaluation and prognosis prediction of pregnancy patients complicated with heart disease.Methods: The clinical data of total 109 cases of pregnancy patients complicated with heart disease by the emergency department in the Second Hospital of Hebei Medical University from 2013.01 to 2016.12 were collected to make a review and analysis,then we used the SPSS 21.0 software to finish the last statistical analysis.Results:1.The structural heart disease composed the largest group of pregnant patients complicated with heart disease received by the emergency department(37 cases of congenital heart disease and 5 cases of rheumatic heart disease,totally 38.5%),the hypertensive heart disease in pregnancy follows(40 cases,36.7%)and the perinatal heart disease as the third category also taking a great proportion(10 cases,9.2%).The additional 15.6% was composed by other forms of heart disease.2.13 of the 42 cases of structural heart disease(37 cases of congenital heart disease and 5 cases of rheumatic heart disease)had undergone a cardiac surgery(30.9%),mainly including atrial or ventricular septal defect repairing and cardiac valve replacement.11 of the 13 patients were classified as cardiac function Ⅱ,and the other 2 were classified as cardiac function Ⅲ and Ⅳ,respectively.Cardiac surgery statistical significance improve the cardiac function of pregnant patients comparing with non-operative group.3.94 live-birth and 15 dead-birth composed the fetal prognosis of the 109 patients,the dead-birth proportions of groups with a Ⅲ-Ⅳ level of cardiac function classification were higher than the groups with Ⅱ level(P<0.01).35 of the 94 live-birth were premature birth and 59 cases were term birth.The premature birth proportions of groups with a Ⅲ-Ⅳ level of cardiac function classification were higher than the groups with a Ⅱ level of cardiac function classification(P<0.01).Moreover,in the 94 live-birth cases,80 cases had a cesarean section operation and 14 had a vaginal delivery,the cesarean of groups with a Ⅲ-Ⅳ level of cardiac function classification were higher than the groups with a Ⅱ level of cardiac function classification(P<0.01).Then,we compared the weight and 5min Apgar score of the neonatals among different levels of cardiac function classification,groups with Ⅲ-Ⅳ level of cardiac function classification were lower than the groups with Ⅱlevel(P<0.05).4.There were significant differences among groups with different cardiac function classification,when comparing the initial plasma NT-pro BNP concentration(P<0.001),the regression fitting curve of the scatter plot of patients’ cardiac function classification and corresponding NT-pro BNP showed the positive correlation between the cardiac function classification and plasma NT-pro BNP concentration(n=96,R2=0.542,P<0.05).5.NT-pro BNP concentrations of different cardiac function classification groups were compared respectively in groups of structural heart disease and hypertensive heart disease in pregnant patients,the plasma NT-pro BNP concentrations of groups withthe Ⅲ or Ⅳ level of cardiac function classification showed a significant higher level than the groups with the classⅡ level of cardiac function classification(P<0.01),while there wasn’t significant difference between the sub groups of structural heart disease and hypertensive heart disease in pregnancy in plasma NT-pro BNP concentrations(P>0.05).Perinatal heart disease group was significantly higher than structural heart disease group and hypertensive heart disease in pregnancy group in plasma NT-pro BNP concentrations(P<0.05).6.The effect of NT-pro BNP for prognosis prediction of structural heart disease patients was examined through the ROC curve,the largest area under the ROC curve was 0.896,with a 95% confidence interval from 0.799 to 0.992,the corresponding optimal cutoff value is 1474.34 pg/ml,and the sensitivity and specificity were 88.9% and 84.8,also the Youden index was calculated as0.737.Conclusions:1.Structural heart disease,hypertensive heart disease in pregnancy and perinatal heart disease were the most important types of diseases which are classified as the pregnancy complicated with heart disease and accepted by our emergency department,and structural heart disease has the highest mortality rates.Cardiac surgery has statistical significance in improving the cardiac function of pregnancy complicated with heart disease patients.2.The cardiac function state of pregnancy complicated with heart disease patients was closely associated with perinatal babies’ outcomes,the probability of adverse perinatal infant as the pregnancy outcomes in patients with cardiac function class Ⅲ or Ⅳ was higher than that in patients with cardiac function Ⅱ.3.NT-pro BNP concentration showed the important clinical value in evaluating the cardiac function state of pregnancy complicated with heart disease patients,but the type of heart disease also should be considered when taking the advantages of plasma NT-pro BNP concentration to evaluate the cardiac function state and predict prognosis of pregnancy complicated with heart disease patients.