Category: Hypertension
Poster Session II
Discriminating between chronic hypertension and superimposed preeclampsia can be clinically challenging; however, accurate diagnoses are necessary given differences in management. We compared the utility of the soluble fms-like tyrosine kinase-1 to placenta-like growth factor ratio (sFlt-1/PlGF), a marker of angiogenic imbalance, to N-terminal brain natriuretic peptide (NT-proBNP), a marker of myocardial stretch, in differentiating between chronic hypertension and superimposed preeclampsia among pregnant patients.
Study Design: This was a secondary analysis of a prospective cohort study of pregnant patients with chronic hypertension undergoing evaluation for superimposed preeclampsia. Maternal blood was collected prior to final clinical diagnosis and providers were blinded to results. The primary outcome was diagnosis of superimposed preeclampsia at the time of evaluation based on ACOG criteria. The predictive abilities of sFlt-1/PlGF >38, an established cut-point used to diagnose preeclampsia, and detectable NT-proBNP ( >50 pg/mL) were evaluated using area under the receiver-operating characteristic curves (AUC).
Results:
Of 51 patients, 22 (43.1%) were diagnosed with superimposed preeclampsia and 29 (56.9%) with chronic hypertension at the time of evaluation. A sFlt-1/PlGF cut-point of >38 had an AUC of 0.86 (95% CI 0.76-0.96) for the diagnosis of superimposed preeclampsia compared to 0.68 (95% CI 0.55-0.81) for NT-proBNP, P=0.02. sFlt-1/PlGF >38 had a sensitivity and specificity of 86.36 (95% CI 65.09-97.09) and 86.21 (95% CI 68.34-96.11), respectively. The positive and negative predictive values of sFlt-1/PlGF were 72.85 (95% CI 51.55-87.12) and 93.65 (95% CI 83.61-97.71), respectively. Compared with NT-proBNP >50 pg/mL, sFlt-1/PlGF >38 had greater sensitivity, specificity, and positive and negative predictive values.
Conclusion: As sFlt-1/PlGF becomes more widely available, it may be a useful tool in discriminating between chronic hypertension and superimposed preeclampsia.
Megan C. Oakes, MD MSCI (she/her/hers)
Maternal-Fetal Medicine
Miller Children's and Women's Hospital
Long Beach, California, United States
Minu Kumari, PhD
Division of Cardiology, Washington University School of Medicine
St. Louis, Missouri, United States
Chen Zhao, BS
Division of Cardiology, Washington University School of Medicine
St. Louis, Missouri, United States
Abhinav Diwan, MD
Division of Cardiology, Washington University School of Medicine
St. Louis, Missouri, United States
Nandini Raghuraman, MD,MSc (she/her/hers)
Assistant Professor
Barnes Jewish Hospital, Washington University in St Louis
St. Louis, Missouri, United States
Kathryn Lindley, MD
Vanderbilt University Medical Center
Nashville, Tennessee, United States