Troponin T Measurement Can Predict Persistent Left Ventricular Dysfunction in Peripartum Cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a disorder of pregnant women that most often asserts itself in the early postpartum period, and whose cause is unknown. With appropriate treatment, some patients recover fully within 6 months, but those who continue to have ventricular dysfunction have a very poor outlook. Prompt recognition of PCM is necessary for appropriate medical management and for counseling about future pregnancies. This prospective multicenter trial examined the prognostic value of serum cardiac troponin (cTnT), which is a specific and very sensitive marker of myocardial injury. Participating were 106 patients with newly diagnosed PPCM who presented to one of 3 teaching hospitals in central China. The criteria for diagnosis of PPCM were congestive heart failure starting in the last month of pregnancy or up to 5 months after delivery, a left ventricular ejection fraction (LVEF) <40%, and no other identifiable cause of cardiac dysfunction. Levels of cTnT were measured and the LVEF was determined by echocardiography within 2 weeks of the onset of cardiomyopathy, and the echocardiogram was repeated 6 months later. The criterion for depressed function was a LVEF <40%. At the time of diagnosis, all the study patients had pulmonary edema and 86% had elevated serum levels of cTnT (0.01 ng/mL or higher). LVEF averaged 27% and improved to an average of 45% by the 6-month follow-up. LVEF returned to normal in 52% of patients, but 48% continued to have left ventricular dysfunction. Initial estimates of cTnT correlated negatively with LVEF at follow-up. The investigators used a cTnT concentration of 0.04 ng/mL as a cutoff value based on published information about the assay used. There were 33 patients whose initial cTnT level exceeded 0.04 ng/mL. After 6 months, these patients had a significantly smaller mean LVEF (35.42%; 95% CI, 13.04%–50.16%) and more persistent left ventricular dysfunction. An elevated cTnT concentration predicted persistent left ventricular dysfunction with a sensitivity of 55% and a specificity of 91%. In this study, the serum cTnT level measured within 2 weeks after the onset of PPCM correlated negatively with the LVEF measured 6 months later. This is a simple, comparatively inexpensive, rapid, and noninvasive means of predicting persistent left ventricular dysfunction in women with PPCM.