NT-proBNP and predictors of event free survival and left ventricular systolic function recovery in peripartum cardiomyopathy

Imran, Tasnim F.; Mohebali, Donya; López, Diana M.; Goli, Rahul R.; DeFilippis, Ersilia M.; Truong, S; Bello, Natalie A.; Gaziano, J. Michael; Djoussé, Luc; Coglianese, Erin; Feinberg, Loryn; Wu, Wen‐Chih; Choudhary, Gaurav; Arany, Zolt; Kociol, Robb D.; Sabe, Marwa

doi:10.1016/j.ijcard.2022.03.052

Cited by 8 publications

(11 citation statements)

References 34 publications

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“…A total of 237 adult women from January 1993 to December 2017 met inclusion criteria for PPCM, of which 229 had RV function recorded at baseline. The cohort selection process has been previously described in detail 9 …”

Section: Methodsmentioning

confidence: 99%

“…[2][3][4][5] Only 40-67% of patients recover left ventricular (LV) systolic function by 1 year. [7][8][9] Prior studies have found that severe LV systolic dysfunction and LV dilatation are risk factors for adverse outcomes in PPCM. 2 However, few studies have examined the prognostic value of right ventricular (RV) dysfunction and clinical predictors of RV dysfunction in this population.…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of PPCM ranges from 1:100 to 1:3000 births with high rates in Nigeria and Haiti 2–5 . Only 40–67% of patients recover left ventricular (LV) systolic function by 1 year 7–9 …”

Section: Introductionmentioning

confidence: 99%

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Clinical predictors of right ventricular dysfunction and association with adverse outcomes in peripartum cardiomyopathy

Imran,

Ataklte,

Khalid

et al. 2023

ESC Heart Failure

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AimsWe sought to identify factors associated with right ventricular (RV) dysfunction and elevated pulmonary artery systolic pressure (PASP) and association with adverse outcomes in peripartum cardiomyopathy (PPCM).Methods and resultsWe conducted a multi‐centre cohort study to identify subjects with PPCM with the following criteria: left ventricular ejection fraction (LVEF) < 40%, development of heart failure within the last month of pregnancy or 5 months of delivery, and no other identifiable cause of heart failure with reduced ejection fraction. Outcomes included a composite of (i) major adverse events (need for extracorporeal membrane oxygenation, ventricular assist device, orthotopic heart transplantation, or death) or (ii) recurrent heart failure hospitalization. RV function was obtained from echocardiogram reports. In total, 229 women (1993–2017) met criteria for PPCM. Mean age was 32.4 ± 6.8 years, 28% were of African descent, 50 (22%) had RV dysfunction, and 38 (17%) had PASP ≥ 30 mmHg. After a median follow‐up of 3.4 years (interquartile range 1.0–8.8), 58 (25%) experienced the composite outcome of adverse events. African descent, family history of cardiomyopathy, LVEF, and PASP were significant predictors of RV dysfunction. Using Cox proportional hazards models, we found that women with RV dysfunction were three times more likely to experience the adverse composite outcome: hazard ratio 3.21 (95% confidence interval: 1.11–9.28), P = 0.03, in a multivariable model adjusting for age, race, body mass index, preeclampsia, hypertension, diabetes, kidney disease, and LVEF. Women with PASP ≥ 30 mmHg had a lower probability of survival free from adverse events (log‐rank P = 0.04).ConclusionsAfrican descent and family history of cardiomyopathy were significant predictors of RV dysfunction. RV dysfunction and elevated PASP were significantly associated with a composite of major adverse cardiac events. This at‐risk group may prompt closer monitoring or early referral for advanced therapies.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical predictors of right ventricular dysfunction and association with adverse outcomes in peripartum cardiomyopathy

Imran,

Ataklte,

Khalid

et al. 2023

ESC Heart Failure

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“…Em relação a avaliação laboratorial, a utilização do peptídeo natriurético do tipo B (BNP) e do peptídeo natriurético do tipo pró BNP (NT -pro BNP) também são úteis para o diagnóstico da CMPP, uma vez que não costumam estar elevados naturalmente durante a gestação (Imran, et al, 2022). Outros marcadores laboratoriais frequentemente utilizados na prática clínica incluem o uso da troponina do tipo T, cujos valores costumam permanecer inalterados na CMPP, tendo em vista a ausência de lesão do miócito cardíaco (Moulig, et al, 2019).…”

Section: Diagnóstico Exames De Imagem E Avaliação Laboratorialunclassified

Avaliação da terapia anticoagulante na cardiomiopatia dilatada puerperal: uma revisão de escopo

Santos¹,

Parreira²,

Alves

et al. 2023

RSD

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A cardiomiopatia dilatada periparto (CMPP) é uma forma de insuficiência cardíaca de origem não identificável, que representa uma importante causa de mortalidade materna não obstétrica no mundo, ocorrendo no último mês de gestação ou meses seguintes após o parto, o aborto ou o aborto espontâneo. Comparativamente a outras formas de cardiomiopatia, a CMPP promove uma maior formação de trombos intracardíacos e sistêmicos, sendo por isso recomendada a administração da terapia anticoagulante como uma estratégia para a prevenção de eventos deletérios. O presente estudo tem como objetivo avaliar a terapia anticoagulante na CMPP. Para esta Revisão de Escopo, realizada através das plataformas PubMed e Science Direct, entre 2018 e 2023, os descritores escolhidos foram ‘’Anticoagulants’’, ‘’Dilated Cardiomyopathy’’ e ‘’Peripartum Period’’. Os critérios de inclusão consistiram em 1) ensaios clínicos, testes controlados e randomizados, revisões e meta-análises, 2) estudos sobre a anticoagulação na CMPP, 3) textos que abordaram o manejo de pacientes portadoras de CMPP anticoaguladas 4) artigos escritos em português, inglês ou espanhol. Os critérios de exclusão incluíram inadequações temáticas, relatos de casos, estudos com animais e textos fora do recorte temporal. As evidências encontradas sugeriram que os principais riscos da anticoagulação na CMPP são o acidente vascular encefálico, a hemorragia materna e o sangramento retroplacentário. A hipertensão arterial sistêmica, as arritmias estruturais e o choque cardiogênico são consideradas complicações frequentes associadas à CMPP. Análises clínicas acerca da toxicidade e de melhores estratégias para a suspensão de anticoagulantes devem ser desenvolvidas, bem como o uso de marcadores no rastreio da CMPP.

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“…Key components of risk assessment include a thorough history, physical examination, and diagnostic work-up including electrocardiogram and echocardiography if there is concern for or known structural heart disease [14]. Prepregnancy measurement of natriuretic peptides [i.e., N-terminal (NT) pro-B-type natriuretic peptide and brain natriuretic peptide (BNP)] may also provide useful prognostic information as recent studies in PPCM have demonstrated that lower initial BNP levels are associated with event free survival [15]. Additionally, subsequent levels during pregnancy may help to diagnose cardiac complications in the setting of a known baseline value [16].…”

Section: Pre-conception Risk Assessment and Counselingmentioning

confidence: 99%

Considerations for specific cardiomyopathies during pregnancy

Abrams

Magun

DeFilippis

2023

Current Opinion in Cardiology

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Purpose of reviewMaternal mortality in the United States continues to increase. Cardiovascular disease, and in particular, cardiomyopathy and heart failure, serves as one of the principal causes of pregnancy-related mortality. The goal of this review is to summarize current knowledge on various cardiomyopathies in pregnancy, with an emphasis on cardiomyopathies beyond the most common in pregnancy, peripartum cardiomyopathy.Recent findingsAlthough existing literature is somewhat limited, outcome studies of cardiomyopathy in pregnancy have demonstrated increased risk for adverse cardiovascular events and maternal morbidity and mortality. Herein, we review and synthesize recent studies focusing on preconception risk and counseling, pharmacologic management, and maternal outcomes in various cardiomyopathies during pregnancy including: dilated cardiomyopathy, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, noncompaction cardiomyopathy, and chemotherapy-induced cardiomyopathy.SummaryIn an effort to optimize maternal outcomes, it is critical to recognize the risk associated with various cardiomyopathies in pregnancy and understand the tools for risk stratification and antepartum management. Further research on less common cardiomyopathies in pregnancy is warranted to provide more standardized recommendations.

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NT-proBNP and predictors of event free survival and left ventricular systolic function recovery in peripartum cardiomyopathy

Cited by 8 publications

References 34 publications

Clinical predictors of right ventricular dysfunction and association with adverse outcomes in peripartum cardiomyopathy

Clinical predictors of right ventricular dysfunction and association with adverse outcomes in peripartum cardiomyopathy

Avaliação da terapia anticoagulante na cardiomiopatia dilatada puerperal: uma revisão de escopo

Considerations for specific cardiomyopathies during pregnancy

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