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Heart failure and cardiomyopathies
Original research article
Association of peripartum troponin I levels with left ventricular relaxation in women with hypertensive disorders of pregnancy
  1. Takeshi Umazume1,
  2. Satoshi Yamada2,
  3. Takahiro Yamada1,
  4. Satoshi Ishikawa1,
  5. Itsuko Furuta1,
  6. Hiroyuki Iwano2,
  7. Daisuke Murai2,
  8. Taichi Hayashi2,
  9. Kazunori Okada3,
  10. Mamoru Morikawa1,
  11. Hiroyuki Tsutsui2 and
  12. Hisanori Minakami1
  1. 1 Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
  2. 2 Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
  3. 3 Faculty of Health Sciences, Hokkaido University Graduate School of Medicine, Sapporo, Japan
  1. Correspondence to Dr Takeshi Umazume; takeuma{at}med.hokudai.ac.jp

Abstract

Objective Women with hypertensive disorders of pregnancy (HDP) show elevated risk of heart failure despite decreased circulating plasma volume compared with those with normotensive control pregnancies (NCP). This study was performed to better characterise the heart in women with HDP and determine whether high-sensitivity troponin I (hs-TnI) around childbirth predicts reduced left ventricular (LV) relaxation at 1 month postpartum.

Methods Echocardiography was performed longitudinally during the first, second and third trimesters and immediately postpartum within 1 week and 1 month postpartum in 24 women with HDP, with simultaneous determination of blood variables in comparison with 51 women with NCP.

Results Compared with NCP, HDP showed greater antepartum left atrial (LA) volume, LV mass and inferior vena cava (IVC) diameter, higher peripartum brain natriuretic peptide/N-terminal pro–B-type natriuretic peptide and hs-TnI with the highest value immediately postpartum, and lower early diastolic mitral annular velocity (e') during pregnancy/postpartum. In analyses of data on HDP and NCP, hs-TnI at the third trimester as well as that immediately postpartum was negatively correlated with later e' at 1 month postpartum. The areas under the receiver operating characteristic curves were 0.82 and 0.81 for hs-TnI at the third trimester and immediately postpartum, respectively, in the prediction of reduced LV relaxation at 1 month postpartum.

Conclusion Reduced LV diastolic function and decreased splanchnic blood reservoir may contribute to the increased third trimester IVC diameter and LA volume in women with HDP. The rise in hs-TnI around childbirth was associated with poor LV relaxation ability at 1 month postpartum.

  • brain natriuretic peptide
  • hypertension
  • pregnancy
  • relaxation
  • troponin
  • preeclampsia

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

https://doi.org/10.1136/openhrt-2018-000829

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    Footnotes

    • Contributors TU, SY, TY, SI, IF, HI, DM, TH, KO, MM, HT and HM participated in the design of the study and collected data on each pregnant woman who participated in this study. TU participated in the design of the study, performed statistical analyses and drafted the manuscript. HM conceived of the study, and participated in its design and coordination, and helped to draft the manuscript. All authors read and approved the final manuscript.

    • Funding This study was funded by Grant-in-Aid for Scientific Research from the Ministry of Education, Science, Sports, and Culture of Japan (grant number: 18K0927908 and 2646246804).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval This prospective observational study was performed in accordance with the provision of the Declaration of Helsinki and was conducted after receiving approval from the Institutional Review Board of Hokkaido University Hospital (013–0262, 4 April 2014).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.