Effect Of Recombinant Human Brain Natriuretic Peptide On Cardiac Function In Peripartum Cardiomyopathy (PPCM)

Objective:The purpose of this study is to assess the effect of recombinant human brain natriuretic peptide on cardiac function in peripartum cardiomyopathy(PPCM).Methods: From January 2013 to July 2016,a total of 61 patients with peripartum cardiomyopathy(PPCM)in the second hospital of Hebei medical university were enrolled into this study.Eligible patients were randomly assigned to receive recombinant human brain natriuretic peptide(rh BNP group)or nitroglycerin(NIT group)by means of random number table.Inclusion criteria: 1)Compliance with the diagnosis of peripartum cardiomyopathy(PPCM)developed by the National Heart Lung and Blood Institute and the Office of Rare Diseases(2000)states: it must develop during the last month of pregnancy or within five months of delivery,the ejection fraction of less than 45%,fractional shortening of less than 30%,or both.Patients had not find heart disease before the last month of delivery and no other reason of heart failure had been found;2)All patients were postpartum transferred to our department;3)Patients or family members of patients had signed surgical informed consent,both husband and wife refused to breastfeeding.Exclusion criteria: 1)Patients with valvular heart disease,myocarditis,hypertrophic or restricted obstructive cardiomyopathy,pericardial disease,pulmonary embolism,primary pulmonary hypertension;2)Patients with cardiac shock;3)Patients with severe liver and kidney function;4)Patients with the taboos of using vasodilator;5)Allergic to rh BNP or nitroglycerin;6)Patients or family members refused to participate in this study.Interventions: Patients in rh BNP group were administrated rh BNP(1.5ug/kg bolus intravenous injection followed by 0.0075ug/kg.min)and according to the level of blood pressure we could add to 0.010-0.030ug/kg.min up to 5 days.Patients in NIT group were administrated nitroglycerin 5ug/min-100ug/min to 5 days according to the level of blood pressure.To ensure the stable of hemodynamics,we could maintain the maximum dose.Then reduced and stopped gradually within 4 hours in both groups.During the treatment the systolic blood pressure of all patients were not less than 85 mm Hg and mean brachial arterial pressure were not less than 65 mm Hg.Both groups were gradually given digitalis,diuretics,β blockers,ACEI or ARBS.Observation of indexes and treatment of statistic: After admission we recorded the basic clinical data of patients,including age,weight,breathing rate,arterial partial pressure of oxygen,oxygen saturation,heart rate,disease of history(hypertention,diabetes,multiple gestation),first-time mothers and multipara proportion,the time of heart failure,NYHA cardiac functional grading,systolic blood pressure,diastolic blood pressure and clinical medication.Record and compared breathing rate,arterial partial pressure of oxygen,oxygen saturation,urine output in 24 hours,heart rate,valve of BNP level,echocardiography examinations,6MWT data monitoring and holter.Echocardiography examinations include: LVEF,LVEDD,E/A.At the same time,adverse reactions were observed during treatment such as allergies,acute kidney damage,headache and hypotension.We followed up the level of BNP and echocardiographic parameters for six month and major adverse cardiac events(MACES)for six month.All statistic data were analyzed by SPSS21.0,it was considered statistical significance when P was lower than 0.05.Results: 1 There was no significant difference between rh BNP group and NIT group in age,weight,breathing rate,arterial partial pressure of oxygen,oxygen saturation,heart rate,disease of history(hypertention,diabetes,multiple gestation),first-time mothers and multipara proportion,the time of heart failure,NYHA cardiac functional grading,systolic blood pressure,diastolic blood pressure and clinical medication(P>0.05).2 Breathing rate slowed down significantly compared with baseline in both groups(P<0.05),which in rh BNP group was more significantly than that in NIT group(24h:21.87±4.36 vs 26.37±3.12,72h:15.52±2.32 vs 18.20±2.06,7days:13.39 ± 1.17 vs 15.27 ± 1.68,all P<0.05).Oxygen partial pressure of arterial blood increased significantly compared with the baseline in both groups(P<0.05),which in rh BNP group was more significantly than that in NIT group(24h:77.61±2.86 vs 74.77±4.35 mm Hg,72h:87.58±1.99 vs 85.64 ± 1.61 mm Hg,7days : 92.19 ± 2.23 vs 89.17 ± 1.70 mm Hg,all P<0.05).Oxygen saturation increased significantly compared with the baseline in both groups(P<0.05),which in rh BNP group was more significantly than that in NIT group(24h:88.42±3.28 vs 86.40±1.98%,72h:90.74±2.57 vs 89.40±1.89%,7days:96.81±2.24 vs 94.30±2.97%,all P<0.05).The urine output in 24 hours increased significantly compared with the baseline in both groups(P<0.05),which in rh BNP group was more significantly than that in NIT group(24h:2352.90±555.54 vs 1765.47±525.75 ml,72h:1473.29±187.10 vs 1243.23±314.31 ml,7days:1008.81±91.17 vs 882.13±89.30 ml,all P<0.05).Heart rate declined obviously compared with the baseline(P<0.05).which in rh BNP group was more significantly than that in NIT group(24h:86.35±8.73 vs 94.77 ±8.01,72h:78.19±6.33 vs 82.67±8.83,7days:69.19±2.86 vs 72.73±3.51,all P<0.05).3 The level of BNP of both groups decreased significantly compared with the baseline in both groups(P<0.05),which in rh BNP group was more significantly than that in NIT group(7days:433.49 ± 158.26 vs 533.69 ±208.97pg/ml,1month:199.52 ±47.37 vs 382.54 ±90.42 pg/ml,6month :148.57±33.54 vs 339.95±76.59 pg/ml,all P<0.05).4 The valve of LVEF in two groups improved significantly compared with the baseline(P<0.05),which in rh BNP group was more significantly than that in NIT group(1month:45.48±2.90 vs 40.25±5.62%,6month:56.67±2.94 vs 47.61±3.46%,both P<0.05).The valve of LVEDD in two groups decreased significantly compared with the baseline(P<0.05),which in rh BNP group was more significantly than that in NIT group after 6 month(42.46±3.51 vs 47.20 ± 5.12 mm,P<0.05).However there was no significant difference in LVEDD between rh BNP group and NIT group after 1month(49.74±4.12 vs 51.04±5.52 mm,P=0.304).The valve of E/A in two groups improved significantly compared with the baseline(P<0.05),which in rh BNP group was more significantly than that in NIT group(1month:1.32±0.03 vs 1.13±0.04,6month: 1.58±0.07 vs 1.38±0.06,both P<0.05).5 The 6-minute walk distance of rh BNP group was significantly longer than that in NIT group in both one month and six month(1month:308.26±34.05 vs 201.43 ±33.73,6month:578.84 ±78.15 vs 457.47 ±43.01,both P<0.05).The 6MWT in six month was significantly longer than that in one month in both groups(P<0.05).6 Holter: In rh BNP group,there was no malignant ventricular arrhythmia,compared with one case of non-sustained ventricular tachycardia in NIT group.There was no significant difference of malignant ventricular arrhythmia(P=0.492).In rh BNP group,there were two cases of atrial tachycardia,compared with four cases in NIT group.There was no significant difference of atrial tachycardia(P=0.637).In rh BNP group,there was one case of atrial fibrillation,compared with two cases in NIT group.There was no significant difference of atrial fibrillation(P=0.977).7 Adverse reactions of two groups: There was no allergic reaction in patients of both groups.There was one case in rh BNP group,while two cases in NIT group suffered from hypotension which did not occur again after adjusting the dose.There was no significant difference of hypotension(P=0.977).There were four cases in NIT group occurred headache,compared with zero case in rh BNP group.There was no significant difference of headache(P=0.113).There was no acute renal injury occurred in both groups.8 MACES: In rh BNP group,there was no malignant ventricular arrhythmia,compared with one case of non-sustained ventricular tachycardia in NIT group.There was no significant difference of malignant ventricular arrhythmia(P=0.492).In rh BNP group,there were two cases of atrial tachycardia,compared with four cases in NIT group.There was no significant difference of atrial tachycardia(P=0.637).In rh BNP group,there was one case of atrial fibrillation,compared with two cases in NIT group.There was no significant difference of atrial fibrillation(P=0.977).There was zero case in rh BNP group with recurrence of heart failure compared with two cases in NIT group(P=0.238).There was no sudden cardiac death in both groups.Conclusions: Compared with nitroglycerin,rh BNP can more effectively improve cardiac function and near and long-term prognosis in peripartum cardiomyopathy.