First Trimester Cardiac Biomarkers among Women with Peripartum Cardiomyopathy: Are There Early Clues to This Late-Pregnancy Phenomenon?

Abstract

Introduction Whether biomarkers may enable early identification of women who develop peripartum cardiomyopathy (PPCM) prior to disease onset remains a question of interest.

Methods A retrospective nested case–control study was conducted to determine whether first trimester N-terminal pro-B type natriuretic peptide (NT-proBNP) or high sensitivity cardiac troponin I (hs-cTnI) differed among women who developed PPCM versus unaffected pregnancies. Cases were matched to unaffected women by age, race, parity, and gestational age of sample (control A) and then further by blood pressure and pregnancy weight gain (control B).

Results First trimester NT-proBNP concentrations were numerically higher among women who subsequently developed PPCM (116 pg/mL [83–177]) as compared with women in control A (56.1 pg/mL [38.7–118.7], p = 0.3) or control B (37.6 [23.3 − 53.8], p <0.05). A higher proportion of women who subsequently developed PPCM (50%) had detectable levels of hs-cTnI as compared with control A (0%, p = 0.03) or control B (18.8%, p = 0.52). Among both cases and controls, hs-cTnI values were low and often below the limit of detection.

Conclusion There were differences in first trimester NT-proBNP and hs-cTnI concentrations between women who subsequently developed PPCM and those who did not, raising the possibility the early pregnancy subclinical myocardial dysfunction may be associated with this late-pregnancy disease.

Key Points

• 1st trimester NT-proBNP is numerically higher among women who subsequently develop PPCM.

• 1st trimester hs-cTnI was nominally higher among women who developed PPCM versus those who did not.

• A significant proportion of normal pregnant women have undetectable hs-cTnI.

Keywords

biomarkers - peripartum cardiomyopathy - troponin - natriuretic peptide

Disclosures

A.A.S. and I.T.G. are supported by an Institutional CRICO Patient Safety Award. J.L.J. reports being a trustee of the American College of Cardiology, receipt of grant support from Novartis Pharmaceuticals and Abbott Diagnostics and honoraria from Abbott, Janssen, Novartis, and Roche Diagnostics, and participation in clinical end point committees and data safety monitoring boards for Abbott, AbbVie, Amgen, Bayer, CVRx, Janssen, and Takeda; he is also supported in part by the Hutter Family Professorship. R.T. reports consultancy agreements with Fresenius Medical Care North America, Thermo Fisher, Moderna, Alnylum, Bayer, Genzyme/Sanofi, Kaneka, FDA, and Novartis; ownership interest in Aggamin LLC and Tvardi; researching funding from National Institutes of Health, Kaneka Corporation, and Genzyme/Sanofi; honoraria from Thermo Fisher, Roche Diagnostics, Pfizer, Merc, Amgen, Genzyme/Sanofi, Bayer, Alnylum, and maternal; patents and inventions with Thermo Fisher and Up-To-Date; and being a scientific advisor or member with Aggamin LLC and Vifor Pharma. M.J.W. reports being a trustee of the American College of Cardiology and on a clinical events committee for Abbvie. C.E.P. is supported by National Institute of Diabetes and Digestive and Kidney Diseases (NIDKK) grant K23-DK-113218 and the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program. There are no other author disclosures.

Publication History

Received: 13 August 2021

Accepted: 01 March 2022

Article published online:
06 May 2022

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