Detection of Peripartum Myocardial Burden by Vector-Projected 187 Channel Electrocardiography and Serum NT-proBNP

Abstract

SummaryThere is no reliable method of screening for pregnant women at high risk of developing severe myocardial disorders. In this study, we used vector-projected 187 channel electrocardiography (DREAM-ECG) and serum biochemical markers to evaluate peripartum myocardial burden in pregnant women. Forty-one pregnant women were examined at 36-37 weeks gestation (GW36), 7 days postpartum (PPD7), and 1 month postpartum (PPM1). Ten non-pregnant control women were assessed at a single time point. Heart rate, sympathetic index, and repolarization index (RTc dispersion) were quantified using the DREAM-ECG system, and serum levels of NT-proBNP, cardiac troponin T, estrogen, and progesterone were determined. Heart rate and the sympathetic index decreased from GW36 to PPM1 (P = 0.0031). The repolarization index decreased over time and was greater than in non-pregnant controls (31 ± 13 ms). Estrogen and progesterone at PPD7 and PPM1 were significantly lower than those at GW36 (P < 0.0001, P < 0.001). NT-proBNP at PPD7 was greater than at GW36 (median 29 pg/mL at GW36, 86 pg/mL at PPD7), and decreased at PPM1 in comparison to PPD7 (median 18.5 pg/mL). Troponin T was in the normal range during the whole period (< 0.003 ng/mL). In conclusion, these results indicate that the peripartum myocardial burden in pregnant women does not return to normal nonpregnant levels by PPM1. We propose that both repolarization indexes such as RTc dispersion by DREAM-ECG and serum biochemical markers may identify pregnant women at high risk of developing severe myocardial damage in the peripartum period. (Int Heart J 2013; 54: 140-145)

Progesterone Changes the Pregnancy-Induced Adaptation of Cardiomyocyte Kv2.1 Channels via MicroRNA-29b

“…Cardiac adaptation in pregnancy cannot be researched by a direct method, but cardiac repolarization is an excellent indirect indicator used to evaluate the peripartum myocardial burden in pregnant women [ 25 ]. In mammalian ventricles, repolarization can strongly regulate cardiac contractility due to its adjustment in absolute and relative refractory periods as well as the calcium concentration in myocardial cells [ 26 – 29 ].…”

Vector synthesis high‐resolution electrocardiography, atrial natriuretic peptide and N‐terminal prohormone brain natriuretic peptide for estimation of cardiac load in pregnancy

“…In 2013, Terata et al . succeeded in analyzing the cardiac load of pregnant and post‐partum women using vector synthesis high‐resolution ECG without echocardiography …”

“…6 In 2013, Terata et al succeeded in analyzing the cardiac load of pregnant and post-partum women using vector synthesis high-resolution ECG without echocardiography. 10 The history of the natriuretic peptide hormone family, known as heart failure markers, began with the discovery of specific granules in guinea pig atrial cells by Krich in 1956. In 1984, Kangawa and Matsuo isolated and identified atrial natriuretic peptide (ANP), which consists of 28 amino acids, from the human atrium.…”