Cardiac biomarkers in twin pregnancies with hypertensive disorders of pregnancy: limited predictive value and a modest adjunctive role.

Authors

Haruna Kawaguchi, Shusaku Hayashi, Ryo Yamamoto, Itaru Yanagihara, Jun Yoshimatsu, Chizuko Aoki-Kamiya

Published in

American journal of obstetrics & gynecology MFM. Pages 102101. Aug 25, 2026. Epub Aug 25, 2026.

Abstract

Twin pregnancies are 1 associated with greater maternal cardiovascular changes and a higher risk of hypertensive disorders of pregnancy (HDP) than singleton pregnancies.(1-4) However, the clinical utility of cardiac biomarkers in this population remains unclear. This study aimed to examine whether longitudinal changes in B-type natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-proBNP), and high-sensitivity cardiac troponin T (hs-cTnT) during pregnancy differ between women with and without HDP, and to assess the predictive performance and adjunctive diagnostic utility of BNP and NT-proBNP using previously established gestational age- specific reference ranges. (5) STUDY DESIGN: This study is a preplanned secondary analysis of a prospective single12 center cohort of women with twin pregnancies. Approval was granted by the Ethical Review Board of Osaka Women's and Children's Hospital. All participants provided written informed consent. The original study established gestational and postpartum reference ranges for cardiovascular biomarkers in uncomplicated twin pregnancies.Longitudinal trajectories of cardiac biomarkers were modeled using generalized additive models for location, scale, and shape. Predictive performance was assessed using samples obtained before HDP onset. Adjunctive diagnostic performance was evaluated using post-onset HDP samples collected at ≥30 weeks' gestation, excluding postpartum measurements. For adjunctive analyses, biomarker values were normalized as multiples of the median (MoM) using gestational age-specific reference ranges. Logistic regression models incorporating MoM values and gestational age were used to generate receiver operating characteristic (ROC) curves. Because 25 ROC-derived thresholds were clinically impractical, a pragmatic cutoff of 2.0 MoM was applied. Test characteristics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated using samples obtained at 34-36 weeks' gestation.
Overall, 205 twin pregnancies were included, 17 of which were discontinued owing to miscarriage or fetal death. Sixty-seven (36%) patients had HDP. Figure 1A-C shows the changes in biomarker levels corresponding to the presence or absence of HDP. In HDP cases, BNP and NT-proBNP levels began to increase around 25 weeks of gestation, peaked at 37 weeks, and decreased to the same level as in non-HDP cases at 4-5 days postpartum. Moreover, hs-cTnT levels were higher in HDP cases than in non- HDP cases from approximately 25 weeks and remained higher even at 4-5 days postpartum. Predictive performance was poor, with area under the curve (AUC) values ranging from 0.5 to 0.6 across gestation. In contrast, adjunctive diagnostic analyses in late gestation demonstrated moderate discrimination (AUC 0.81 for BNP and NT-proBNP). However, substantial overlap between HDP and non-HDP pregnancies resulted in clinically impractical ROC-derived thresholds.At a pragmatic cutoff of 2.0 MoM at 34-36 weeks' gestation, biomarkers demonstrated moderate sensitivity and specificity with relatively high negative predictive value but modest positive predictive value .
Although cardiac biomarkers are elevated in twin pregnancies complicated by HDP, their predictive value is limited.

PMID:
42641956
Bibliographic data and abstract were imported from PubMed on 26 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.