Poorer Recovery in Peripartum Cardiomyopathy With High Levels of NT-proBNP

Women with peripartum cardiomyopathy (PPCM) with N-terminal pro-brain natriuretic peptide (NT-proBNP) levels ≥900 pg/mL may have poorer recovery, according to a study published in Clinical Research in Cardiology.

Women (N=35; mean age, 30.0±5.9 years; 45.7% multiparous) with PPCM treated at the Groote Schuur Hospital in South Africa were recruited between 2013 and 2018. Patients were evaluated with 12-lead electrocardiogram, echocardiogram, and for renal function, and plasma NT-proBNP levels. LV recovery was evaluated at 12 months.

In this cohort, 40% had New York Heart Association (NYHA) class III or IV, median systolic blood pressure was 112 mm Hg (interquartile range [IQR], 105-138 mmHg), diastolic blood pressure was 76 mmHg (IQR, 70-85 mmHg), LV ejection fraction was 31% (IQR, 24%-39%), LV end-diastolic diameter was 35 mm (IQR, 33-39 mm), and median baseline NT-proBNP was 834.7 pg/mL (IQR, 571.2-1840.5 pg/mL).

At 1 year, 51.4% of women had recovery of LV dimensions and systolic function. Women with vs without LV improvement had lower rates of sinus tachycardia (11% vs 59%, respectively; P =.012), lower heart rates (83±15 vs 98±22 beats per minute, respectively; P =.025), and lower rates of NYHA class III or IV (22.2% vs 58.8%, respectively; P =.041) at baseline.

Women with NP-proBNP levels ≥900 pg/mL vs <900 pg/mL had significantly higher LV end-diastolic diameter (mean, 58±6.66 vs 49.9±5.05 mm, respectively; P <.001) and greater rates of LV ejection fraction <50% (68.4% vs 31.3%, respectively; P =.028) at 1 year. NP-proBNP level ≥900 pg/mL was found to predict failure to achieve normal LV end-diastolic diameter (<55 mm; odds ratio [OR], 0.22; 95% CI, 0.05-0.95; P =.043) or LV ejection fraction (≥50%; OR, 0.20; 95% CI, 0.04-0.89; P =.035).

NT-proBNP levels correlated with LV end-diastolic diameter (r, 0.420; P =.012) and heart rate (r, 0.344; P =.043) but not with systolic (P =.751) or diastolic (P =.467) blood pressure, LV ejection fraction (P =.085), left atrial diameter (P =.348), body mass index (P =.381), or creatinine concentration (P =.217).

This study was limited by its small sample size and may have included some referral bias as this center was a tertiary hospital to which the most severe cases are referred.

“The application of [point-of-care] NT-proBNP testing should be further studied for its use of diagnosis and risk stratifcation for patients with PPCM,” concluded the study authors.

Reference

Hoevelmann J, Muller E, Azibani F, et al. Prognostic value of NT‑proBNP for myocardial recovery in peripartum cardiomyopathy (PPCM). Clin Res Cardiol. Published online February 8, 2021. doi:10.1007/s00392-021-01808-z