Abstract 1959: Evidence That Plasma C-Reactive Protein May Provide Diagnostic Help In Peripartum Cardiomyopathy
Background: Peripartum cardiomyopathy (PPCM), often associated with an inflammatory process, is defined as heart failure in the last month of pregnancy or during the first 5 months postpartum in a previously healthy woman. Plasma high sensitivity C-Reactive Protein (CRP), an indicator of proinflammatory cytokine release, has been shown to be uniformly and significantly elevated in Haitian PPCM patients compared to Haitian control mothers at the same stage peripartum. This report documents these findings, showing why this test may be useful in helping to confirm the diagnosis of PPCM.
Methodology: PPCM patients were identified from a PPCM Registry initiated at Hôpital Albert Schweitzer, Deschapelles, Haiti in 2000. Age and parity-matched Haitian mothers served as controls. All blood draws for plasma high sensitivity CRP were done in PPCM patients at diagnosis and in controls at the same stage peripartum. Prospective controls were also screened by physical exam and echocardiography. Plasma levels of CRP were determined by non-competitive capture ELISA immunoassay.
Results: Table⇓: Plasma high sensitivity-C-Reactive Protein in Peripartum Cardiomyopathy and Control Mothers, Deschapelles, Haiti: Using a “cut-off” value of plasma CRP of 10 mg/L, the specificity was 100 % and the sensitivity was 93 %. Echocardiography in prospective controls identified two apparently healthy control patients with plasma CRP > 10 mg/L (14 and 21.7 mg/L) with asymptomatic dilated cardiomyopathy (possible forme fruste PPCM).*
Conclusion: Plasma CRP has been shown to be significantly elevated in Haitian patients with peripartum cardiomyopathy compared with Haitian control patients at the same stage peripartum. Levels of plasma CRP ≥ 10 mg/liter at diagnosis suggest possible inflammatory cardiomyopathy and levels ≤ 10 mg/liter may render the diagnosis of new PPCM suspect. * We have also identified plasma CRP levels of 157, 59, 105 mg/L on 3 of 3 tested USA PPCM patients at diagnosis.