Prospective study on changes in blood variables in pregnant women at higher risk of peripartum cardiomyopathy

Abstract

Aims: Echocardiography is necessary for the diagnosis of peripartum cardiomyopathy (PPCM). Multifetal pregnancies (MFP) and hypertensive disorders (HD) are prominent risk factors for PPCM. To determine which blood variables exhibit greater change in a late stage of pregnancy in women with MFP and/or HD compared with women with normotensive singleton pregnancies. Methods and results: Serum levels of six variables—high-sensitive troponin I (hs-TnI), N-terminal fragment of precursor protein brain-type natriuretic peptide (NT-proBNP), myoglobin, creatine kinase-myocardial band, ferritin, and prolactin—were compared between 29 women with MFP (n = 13) and/or HD (n = 18) and 100 women with normotensive singleton pregnancies (control group). None of 129 women developed PPCM. All variables increased significantly peripartum in both groups. In 29 women with MFP and/or HD, the elevated hs-TnI and NT-proBNP levels (median) were significantly higher compared with the control group (5.4 vs. 3.7 pg/mL for hs-TnI with P = 0.002, 185 vs. 68 pg/mL for NT-proBNP with P = 0.007), and the prevalence rate of more than 90th percentile value specific for the 129 women was significantly more frequent for hs-TnI (>12.2 pg/mL; 31% [9/29] vs. 4.0% [4/100], P < 0.001) and tended to be more frequent for NT-proBNP (>342 pg/mL; 21% [6/29] vs. 7.0%, P = 0.072). Conclusions: Both hs-TnI and NT-proBNP were likely to increase markedly in women with MFP and/or HD. The combination of hs-TnI and NT-proBNP may contribute to better selection of candidates for echocardiography.