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. 2021 Aug;110(8):1259-1269.
doi: 10.1007/s00392-021-01808-z. Epub 2021 Feb 8.

Prognostic value of NT-proBNP for myocardial recovery in peripartum cardiomyopathy (PPCM)

J Hoevelmann  1   2 , E Muller  1 , F Azibani  1 , S Kraus  1   3 , J Cirota  3 , O Briton  1 , M Ntsekhe  1   3 , N A B Ntusi  1   3   4 , K Sliwa  5   6 , C A Viljoen  1   3
Affiliations

Prognostic value of NT-proBNP for myocardial recovery in peripartum cardiomyopathy (PPCM)

J Hoevelmann et al. Clin Res Cardiol. 2021 Aug.

Abstract

Introduction: Peripartum cardiomyopathy (PPCM) is an important cause of pregnancy-associated heart failure worldwide. Although a significant number of women recover their left ventricular (LV) function within 12 months, some remain with persistently reduced systolic function.

Methods: Knowledge gaps exist on predictors of myocardial recovery in PPCM. N-terminal pro-brain natriuretic peptide (NT-proBNP) is the only clinically established biomarker with diagnostic value in PPCM. We aimed to establish whether NT-proBNP could serve as a predictor of LV recovery in PPCM, as measured by LV end-diastolic volume (LVEDD) and LV ejection fraction (LVEF).

Results: This study of 35 women with PPCM (mean age 30.0 ± 5.9 years) had a median NT-proBNP of 834.7 pg/ml (IQR 571.2-1840.5) at baseline. Within the first year of follow-up, 51.4% of the cohort recovered their LV dimensions (LVEDD < 55 mm) and systolic function (LVEF > 50%). Women without LV recovery presented with higher NT-proBNP at baseline. Multivariable regression analyses demonstrated that NT-proBNP of ≥ 900 pg/ml at the time of diagnosis was predictive of failure to recover LVEDD (OR 0.22, 95% CI 0.05-0.95, P = 0.043) or LVEF (OR 0.20 [95% CI 0.04-0.89], p = 0.035) at follow-up.

Conclusions: We have demonstrated that NT-proBNP has a prognostic value in predicting LV recovery of patients with PPCM. Patients with NT-proBNP of ≥ 900 pg/ml were less likely to show any improvement in LVEF or LVEDD. Our findings have implications for clinical practice as patients with higher NT-proBNP might require more aggressive therapy and more intensive follow-up. Point-of-care NT-proBNP for diagnosis and risk stratification warrants further investigation.

Keywords: Heart failure; Left ventricular recovery; NT-proBNP; Peripartum cardiomyopathy; Risk stratification.

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Conflict of interest statement

The authors have no conflicting interests to disclose.

Figures

Fig. 1
Fig. 1
Change of LV dimensions and LV systolic function between diagnosis and one-year follow-up as classified by NT-proBNP < or ≥ 900 pg/ml
Fig. 2
Fig. 2
Correlation between NT-proBNP and clinical, biochemical and echocardiographic parameters
See this image and copyright information in PMC

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