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Peripartum subclinical myocardial ischemia using Troponin T- an observational pilot study.
Abstract Number: O1 4
Abstract Type: Original Research
The most recent report from the Centre for Maternal and Child Enquiries (CEMACE) on maternal mortality in the United Kingdom found cardiac disease to be the most common cause of death amongst mothers (1). Identifiable risk factors that placed the women who died at greater risk of cardiac disease were common to many of the women. The prevalence of non-fatal myocardial ischemia amongst parturients is unknown. Troponin is the most sensitive biochemical marker of cardiac damage (2). Troponin levels are not elevated during normal pregnancy (2) and are not routinely monitored in the peripartum period. We set out to explore the prevalence of peripartum subclinical ischemia as evaluated by Troponin T levels in parturients measured within 24 hours of delivery.
All women in our institution that gave birth to live infants either vaginally or by cesarean delivery, from June to September 2012, were considered eligible. After consenting to the study, participants were allocated to one of two groups, depending on if they were considered to be at high or low risk of subclinical myocardial ischemia. Inclusion criteria for the high-risk group included the following: Age > 35 years; morbid obesity (BMI >40); smokers; pre-existing hypertension or cardiac disease; severe pre-ecclampsia; HELLP syndrome; a family history of myocardial ischemia; pre-existing type I or II diabetes; post partum hemorrhage requiring transfusion or unplanned hysterectomy; and recent immigrants. All women that did not fulfill these criteria were considered to be at low risk for myocardial damage. Blood samples were collected 8 - 24 hours after delivery on the postnatal ward.
A total of 201 women were approached of which 142 (70.6%) consented to the study. Two were excluded for technical reasons, and 59 declined to participate. Of the 140 included in the analysis, 91 (65%) women were considered at high risk and 49 (35%) at low risk of myocardial strain.
The mean Troponin T results for both the high and low risk groups were within the normal range of < 14 ng/L. Six women (4.3%) had an elevated Troponin T result. Two (2.2%) were from the high risk group, and 4 (8.2%) were from the low risk group. Only one patient experienced cardiovascular symptoms.
The prevalence of subclinical myocardial strain in our study was 3.6%. The risk factors for this subclinical myocardial ischemia remain to be identified, as does the management plan following a positive result.
1. Cantwell et al. Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. BJOG 2011 Mar 1;118 Suppl 1:1–203.
2. Shivvers SA, Wians FH, Keffer JH, Ramin SM. Maternal cardiac troponin I levels during normal labor and delivery. Am J Obstet Gynecol. 1999 Jan;180(1 Pt 1):122.