Cardiac biomarkers in women with high-risk pregnancies: short-term outcomes from the Heidelberg Cardio-Obstetrics Registry

BACKGROUND: Pregnancy leads to profound physiological changes within the cardiovascular system. However, in women with pre-existing or pregnancy-associated cardiovascular disease (CVD) these adaptations may be insufficient and lead to maternal or fetal complications. The prognostic value of cardiac biomarkers such as N-terminal B-type natriuretic peptide (NTproBNP) and high-sensitivity cardiac troponin-T (hscTnT) in this population remains unclear. MATERIAL AND METHODS: In this prospective, single-center cohort study, we included women with pre-existing CVD or who developed CVD during pregnancy. Patients were assessed before pregnancy, during each trimester, and in the postpartum period, when feasible. Biomarker trajectories (NT-proBNP, hs-cTnT) were recorded and their association with maternal complications at delivery was evaluated. Diagnostic accuracy was estimated using receiver operating characteristic curves (ROC). RESULTS: 67 women were included (median age 33.0 years, IQR 30.0-37.0): 46 patients (73.1%) with pre-existing CVD and 21 patients (31.3%) who developed CVD during pregnancy. 50 women were observed until delivery and in 30 cases (60%) a maternal and/or fetal complication occurred at birth. Peak NT-proBNP demonstrated good discrimination for maternal complications (AUC 0.722; 95% CI 0.552-0.892) with an optimal cut-off of 209 ng/L (sensitivity 72%, specificity 67%, Youden 0.39). Peak hs-cTnT showed good discrimination as well (AUC 0.729; 95% CI 0.568-0.890) with a cut-off of 22.0 pg/mL (sensitivity 55%, specificity 84%, Youden 0.39). DISCUSSION: In this high-risk real-world cohort of pregnant women with CVD, maternal and/or fetal complications at delivery were common. Elevated NT-proBNP-and to a lesser extent hs-cTnT-was associated with higher complication rates and showed potential for improving risk stratification and monitoring. These findings support multidisciplinary surveillance of pregnant women with CVD and warrant further investigation in larger, multicenter studies.