Limited value of NT-pro BNP in patients with Peripartum Cardiomyopathy.pdf

1、Background and Aim
　　Peripartum cardiomyopathy (PPCM) is a rare type of dilated cardiomyopathy in which left ventricular dysfunction occurs in women in their childbearing age. In recent years, measurements of serum le

2、vels of neurohormone BNPhave evolved into an important blood test in the diagnosis and treatment of congestive heart failure.The aim of this study is to accessthe value of NT pro-BNP in helping with the diagnosis and pro

3、gnosis of PPCM.
　　Methods
　　A retrospective study was done involving 59 newly diagnosed PPCM patients in their peripartum and postpartum period with mean age of 26.7±4.7 years, who were admitted in Union Hospital,

4、Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China during the period May 2008 to August 2011. Patient’s clinical data, medical history, echocardiography findings, NT-proBNP levels, ECG

5、and blood investigations were recorded and analyzed. Patients were then divided into four different groups according to their NT-proBNP levels (Group I:1,000-3,000 pg/ml, Group II: 3,001-6,000 pg/ml, Group III: 6,001-10,

6、000 pg/ml and Group IV: >10,000 pg/ml) and each group’s LV size and LVEF were evaluated. Moreover, each group was compared with the other and analyzed including all the parameters.All the patients were treated with stand

7、ard therapy for heart failure that included diuretics, digitalis, spironolactone, beta-blockers, ACEI and aspirin.
　　Results
　　All the patients included in the study presented with symptoms of heart failure and non

8、e of them had past illness related to heart diseases and any other systemic illness. NT-proBNP levels were elevatedin all the cases ranging from 1341 to 13657 pg/ml. Majority of the patients fell under the group II (grou

9、p I n=18, group II n=21, group III n=18 and group IV n=2) as per our group division. Most of the patients had increased left heart chambers (LA: mean 4.08±0.59 cm, LV: mean 5.77±0.67 cm, RA: mean 4.2±0.62 cm, RV:mean 3.9

10、±0.58 cm) and decreased left ventricular systolic function with more patient under NYHA class III (NYHA class I n=0, class II n=5 class III n=42 and class IV n=12, LVEF:mean 36.91±10.13％and FS:mean 18.64±6.11%). No stati

11、stically significant correlation was found between increased NT-proBNP levels and the left ventricular systolic function (Pearson’s correlation between left ventricular size and NT-proBNPp=0.075, LVEF and NT-proBNPp=0.48

12、, FS and NT-proBNPp=0.38). The LV size and LVEF of each group were also compared with the other three groups by one-way ANOVA test and was found to be statistically insignificant (LV size p=0.397 and LVEF p=0.381) with t

13、he levels of NT-proBNP. Ten of the patients had biventricular failure (2 in group I, 3 in group II and 5 in group III). Except in total protein (p=0.015) (between group I and II and group I and III) and albumin (p=0.013)

14、 (between group I and III comparing cardiac enzymes, liver function test, renal function test, lipid profile between different groups using one-way ANOVA test statistical significance was not obtained. The mean duration

15、of hospitalization was 13.11±7.39 days, 14.28±8.48 days, 8.44±3.11 days and 6±5.6 days in group I, II, III and IV respectively and its relationship with NT-proBNP was statistically insignificant with p value of 0.06.

16、　　Conclusion
　　NT-proBNP is an important investigation for diagnosis and prognosis of heart failure. However, our study in cases of PPCM showed relatively similar diagnostic and prognostic role of the invasive NT-proB

17、NP test with that of other non-invasive tests like Echocardiography and NYHA while having no statistical significance with left ventricular systolic function thus questioning its significance over the simpler non-invasiv