Sarma Amy A, Hsu Sarah, Januzzi James L, Goldfarb Ilona T, Thadhani Ravi, Wood Malissa J, Powe Camille E, Scott Nandita S
Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
Am J Perinatol. 2023 Jan;40(2):137-140. doi: 10.1055/s-0042-1748159. Epub 2022 May 6.
Whether biomarkers may enable early identification of women who develop peripartum cardiomyopathy (PPCM) prior to disease onset remains a question of interest.
A retrospective nested case-control study was conducted to determine whether first trimester -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).
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], = 0.3) or control B (37.6 [23.3 - 53.8], <0.05). A higher proportion of women who subsequently developed PPCM (50%) had detectable levels of hs-cTnI as compared with control A (0%, = 0.03) or control B (18.8%, = 0.52). Among both cases and controls, hs-cTnI values were low and often below the limit of detection.
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.
· First trimester NT-proBNP is numerically higher among women who subsequently develop PPCM.. · First 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..
生物标志物能否在疾病发作前早期识别出发生围产期心肌病（PPCM）的女性仍是一个备受关注的问题。
进行了一项回顾性巢式病例对照研究，以确定孕早期 - 氨基末端脑钠肽前体（NT-proBNP）或高敏心肌肌钙蛋白I（hs-cTnI）在发生PPCM的女性与未受影响的妊娠女性之间是否存在差异。病例与未受影响的女性按年龄、种族、产次和样本的孕周（对照A）进行匹配，然后进一步按血压和孕期体重增加进行匹配（对照B）。
与对照A组女性（56.1 pg/mL [38.7 - 118.7]，P = 0.3）或对照B组女性（37.6 [23.3 - 53.8]，P < 0.05）相比，随后发生PPCM的女性孕早期NT-proBNP浓度在数值上更高（116 pg/mL [83 - 177]）。与对照A组（0%，P = 0.03）或对照B组（18.8%，P = 0.52）相比，随后发生PPCM的女性中hs-cTnI可检测水平的比例更高（50%）。在病例组和对照组中，hs-cTnI值均较低，且常低于检测限。
随后发生PPCM的女性与未发生PPCM的女性在孕早期NT-proBNP和hs-cTnI浓度上存在差异，这增加了早孕期亚临床心肌功能障碍可能与这种晚孕期疾病相关的可能性。
· 随后发生PPCM的女性孕早期NT-proBNP在数值上更高。· 发生PPCM的女性孕早期hs-cTnI名义上高于未发生者。· 相当一部分正常孕妇的hs-cTnI无法检测到。
