| Background and AimPeripartum cardiomyopathy (PPCM) is a rare type of dilatedcardiomyopathy in which left ventricular dysfunction occurs in women intheir childbearing age. In recent years, measurements of serum levels ofneurohormone BNPhave evolved into an important blood test in thediagnosis and treatment of congestive heart failure.The aim of this study isto accessthe value of NT pro-BNP in helping with the diagnosis andprognosis of PPCM.MethodsA retrospective study was done involving59newly diagnosed PPCMpatients in their peripartum and postpartum period with mean age of26.7±4.7years, who were admitted in Union Hospital, Tongji MedicalCollege of Huazhong University of Science and Technology, Wuhan, Chinaduring the period May2008to August2011. Patient’s clinical data, medicalhistory, echocardiography findings, NT-proBNP levels, ECG and bloodinvestigations were recorded and analyzed. Patients were then divided intofour different groups according to their NT-proBNP levels (Group I:1,000- 3,000pg/ml, Group II:3,001-6,000pg/ml, Group III:6,001-10,000pg/mland Group IV:>10,000pg/ml) and each group’s LV size and LVEF wereevaluated. Moreover, each group was compared with the other and analyzedincluding all the parameters.All the patients were treated with standardtherapy for heart failure that included diuretics, digitalis, spironolactone,beta-blockers, ACEI and aspirin.ResultsAll the patients included in the study presented with symptoms of heartfailure and none of them had past illness related to heart diseases and anyother systemic illness. NT-proBNP levels were elevatedin all the casesranging from1341to13657pg/ml. Majority of the patients fell under thegroup II (group I n=18, group II n=21, group III n=18and group IV n=2) asper our group division. Most of the patients had increased left heartchambers (LA: mean4.08±0.59cm, LV: mean5.77±0.67cm, RA: mean4.2±0.62cm, RV: mean3.9±0.58cm) and decreased left ventricular systolicfunction with more patient under NYHA class III (NYHA class I n=0, classII n=5class III n=42and class IV n=12, LVEF: mean36.91±10.13%and FS:mean18.64±6.11%). No statistically significant correlation was foundbetween increased NT-proBNP levels and the left ventricular systolicfunction (Pearson’s correlation between left ventricular size and NT-proBNPp=0.075, LVEF and NT-proBNPp=0.48, FS and NT-proBNPp=0.38). The LV size and LVEF of each group were also comparedwith the other three groups by one-way ANOVA test and was found to bestatistically insignificant (LV size p=0.397and LVEF p=0.381) with thelevels of NT-proBNP. Ten of the patients had biventricular failure (2in group I,3in group II and5in group III). Except in total protein (p=0.015)(between group I and II and group I and III) and albumin (p=0.013)(between group I and III comparing cardiac enzymes, liver function test,renal function test, lipid profile between different groups using one-wayANOVA test statistical significance was not obtained. The mean duration ofhospitalization was13.11±7.39days,14.28±8.48days,8.44±3.11days and6±5.6days in group I, II, III and IV respectively and its relationship withNT-proBNP was statistically insignificant with p value of0.06.ConclusionNT-proBNP is an important investigation for diagnosis and prognosis ofheart failure. However, our study in cases of PPCM showed relativelysimilar diagnostic and prognostic role of the invasive NT-proBNP test withthat of other non-invasive tests like Echocardiography and NYHA whilehaving no statistical significance with left ventricular systolic function thusquestioning its significance over the simpler non-invasive investigative andevaluative measures. |
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