natriuretic-peptide--brain and Puerperal-Disorders

Peripartum cardiomyopathy (PPCM) is a rare but potentially lethal complication of pregnancy occurring in approximately 1 : 3,000 live births in the United States although some series report a much higher incidence. African-American women are particularly at risk. Diagnosis requires symptoms of heart failure in the last month of pregnancy or within five months of delivery in the absence of recognized cardiac disease prior to pregnancy as well as objective evidence of left ventricular systolic dysfunction. This paper provides an updated, comprehensive review of PPCM, including emerging insights into the etiology of this disorder as well as current treatment options.

Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Cardiomyopathies; Cytokines; Dyspnea; Edema; Electrocardiography; Female; Humans; Natriuretic Peptide, Brain; Pregnancy; Pregnancy Complications, Cardiovascular; Prognosis; Puerperal Disorders; Risk Factors; Stroke Volume; Tachycardia; Troponin T; Ventricular Dysfunction, Left

Topics: Biomarkers; Biopsy; C-Reactive Protein; Cardiomyopathies; Early Diagnosis; Female; Heart-Assist Devices; Humans; Incidence; Natriuretic Peptide, Brain; Parity; Postnatal Care; Pregnancy; Pregnancy Complications, Cardiovascular; Prenatal Care; Prognosis; Puerperal Disorders; Rare Diseases; Risk Factors; Treatment Outcome; Troponin; United States

To determine predictors of adverse outcomes in peripartum cardiomyopathy (PPCM).. We conducted a multi-center cohort study across four centers to identify subjects with PPCM with the following criteria: LVEF <40%, development of heart failure within the last month of pregnancy or within 5 months of delivery and no other identifiable cause of heart failure with reduced ejection fraction. Outcomes included 1) survival free from major adverse events (need for extra-corporeal membrane oxygenation, ventricular assist device, orthotopic heart transplantation or death) and 2) LVEF recovery ≥ 50%. Using a univariate logistic regression analysis, we identified significant clinical predictors of these outcomes, which were then used to create multivariable models. NT-proBNP at the time of diagnosis was examined both as a continuous variable (log transformed) in logistic regression and as a dichotomous variable (values above and below the median) using the log-rank test. In all, 237 women (1993 to 2017) with 736.4 person-years of follow-up, met criteria for PPCM. Participants had a mean age of 32.4 ± 6.7 years, mean BMI 30.6 ± 7.8 kg/m2; 63% were White. After median follow-up of 3.6 years (IQR 1.1-7.8), 113 (67%) had LVEF recovery, and 222 (94%) had survival free from adverse events. Significant predictors included gestational age, gravidity, systolic blood pressure, smoking, heart rate, initial LVEF, and diuretic use. In a subset of 110 patients with measured NTproBNP levels, we found a higher event free survival for women with NTproBNP <2585 pg/ml (median) as compared to women with NTproBNP ≥2585 pg/ml (log-rank test p-value 0.018).. Gestational age, gravidity, current or past tobacco use, systolic blood pressure, heart rate, initial LVEF and diuretic requirement at the time of diagnosis were associated with survival free from adverse events and LVEF recovery. Initial NT-proBNP was significantly associated with event free survival.

Topics: Adult; Cardiomyopathies; Cohort Studies; Diuretics; Female; Heart Failure; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Peripartum Period; Pregnancy; Progression-Free Survival; Puerperal Disorders; Recovery of Function; Stroke Volume; Ventricular Function, Left

Topics: Adolescent; Adult; Asymptomatic Infections; Betacoronavirus; C-Reactive Protein; Chest Pain; Coronavirus Infections; COVID-19; Edema; Female; Ferritins; Fibrin Fibrinogen Degradation Products; Humans; Magnetic Resonance Imaging; Magnetic Resonance Imaging, Cine; Male; Myocarditis; Natriuretic Peptide, Brain; Pandemics; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious; Puerperal Disorders; SARS-CoV-2; Troponin I; Troponin T

Peripartum cardiomyopathy (PPCM) is life-threatening and its diagnosis is a challenge. We highlight the clinical characteristics and bio-markers of PPCM and the proper differential diagnosis of peripartum dyspnea to aim to make an early diagnosis available.We analyzed 262 peripartum patients with dyspnea, and summed up the final diagnosis. The clinical data of the control group and the PPCM group as well as before and after the treatment of the PPCM group were compared.In total, 147 (56%) of the perinatal patients were physiologic dyspnea of pregnancy; only 11 (4%) patients met the PPCM diagnostic criteria. Compared with the basic baseline characteristics between the PPCM group and control group, patients with PPCM had a higher heart rate, and the white blood cell, high-sensitivity C-reactive protein (hs-CRP), and B-type natriuretic peptide (BNP) levels were markedly elevated, whereas PaO2 and left ventricular ejection fraction (LVEF) were lower. The heart rate, CRP and BNP levels were lower at the follow-up compared with the pretreatment. Patients who were followed up showed significant improvements in the LVEF and New York Heart Association function class.We standardized the symptoms of dyspnea for calculating, and analyzed the diagnostic efficacy of laboratory indicators. The research highlighted that the use of echocardiography and disease-specific bio-markers may aid in the diagnosis and management.

Topics: Adult; Biomarkers; C-Reactive Protein; Cardiomyopathies; Dyspnea; Female; Heart Rate; Humans; Leukocyte Count; Natriuretic Peptide, Brain; Peripartum Period; Postpartum Period; Puerperal Disorders; Stroke Volume; Young Adult

Peripartum cardiomyopathy (PPCM) is a potentially fatal form of heart failure and the recognition of its risk factors is important for prevention and treatment.. To explore the clinical characteristics and the risk factors for PPCM.. Echocardiographic was used to examine the left ventricular ejection fraction (LVEF). Blood level of troponin I (cTNI), high sensitive C-reaction protein (hs-CRP), NT-proBNP was measured. All PPCM occurred within weeks following delivery.. Fifty-two PPCM patients and 52 normal delivery subjects (control group) were included in this study. Compared with the control group, PPCM patients were older, with a higher level of blood pressure, and a higher rate of suspected respiratory infection. The level of leucocytes, hs-CRP, cTNI and NT-proBNP in PPCM patients were higher than in the control. Multivariate logistic regression analysis showed that elevated plasma hs-CRP (OR =1.86, p<0.05), respiratory infection (OR = 2.87, p<0.01), and hypertension (OR =1.68, p < 0.05) were independent risk factors for PPCM. During the follow up of 21.6±5.4 d, one patient (1.9%) died probably of heart failure but other patients remained well.. Hypertension, respiratory infection, and elevated plasma hs-CRP seem to be associated with the pathogenesis of peripartum cardiomyopathy in this patient population.

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Cardiomyopathy, Dilated; Case-Control Studies; China; Diuretics; Echocardiography, Doppler; Female; Follow-Up Studies; Heart Failure; Hospitalization; Hospitals, Teaching; Humans; Logistic Models; Natriuretic Peptide, Brain; Peptide Fragments; Peripartum Period; Pregnancy; Pregnancy Complications, Cardiovascular; Prospective Studies; Puerperal Disorders; Risk Factors; Socioeconomic Factors; Ventricular Function, Left

The aetiology of peripartum cardiomyopathy (PPCM) is still largely unknown. Recent evidence suggests that the breakdown products from prolactin can induce cardiomyopathy. Prolactin secretion can be reduced with bromocriptine which had beneficial effects in a small study. We present a case of a patient with PPCM who received cabergoline, a strong and long lasting antagonist of prolactin secretion. Following treatment, her prolactin levels dropped swiftly. N-terminal pro-BNP levels, which had remained high up to that point, dropped within 1 day (7006 to 4408 pg/mL). Echocardiographic left ventricular ejection fraction recovered from 26% on day 4 postpartum to 32% and later 47% on days 2 and 5 after cabergoline treatment. To our knowledge, this is the first description of a case of PPCM in which cabergoline was administered.

Topics: Adult; Cabergoline; Cardiomyopathies; Echocardiography; Ergolines; Female; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pregnancy; Prolactin; Puerperal Disorders; Ventricular Dysfunction, Left

Topics: Adult; C-Reactive Protein; Cardiomyopathies; Female; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pregnancy; Pregnancy Complications, Cardiovascular; Puerperal Disorders; Recovery of Function