P5356NT-proBNP is a valuable diagnostic tool of heart failure even during post partum period

Abstract Background Post-partum period is characterized by complex haemodynamic changes that may lead to heart failure (HF) in a minority of patients. B-type natriuretic peptides inactive amino terminal fragment (NT-proBNP) is an established biomarker in the management of HF. Patients presenting with dyspnea are considered at high risk of HF if NT-proBNP is above 125 pg/ml. Higher levels of NT-proBNP in the post natal period were reported to be associated with increased risk of cardiovascular events, but there is no defined cut-off value established for prediction of HF in this setting. Purpose We conducted this study to identify an adequate cut-off value which would predict haemodynamic overload among post-partum women. Methods All women who gave informed consent during an obstetric clinical evaluation at our tertiary centre between 01/01/2018 and 30/09/2018 were included in the study. NT-proBNP was measured within 24 hours from delivery. The primary endpoint of the study was the development of signs and symptoms of heart failure (with the need of intravenous diuretics or a cardiological evaluation) within 15 days after delivery. We therefore analyzed the ability of different cut-off of NT-proBNP values in predicting the primary outcome. Confidence intervals (CI) for sensitivity and specificity were calculated with the Wilson score method. Results 252 women were included in the study. Eleven of them developed in the study timeframe signs and symptoms of HF (4.3%); all of them were treated with diuretics. Nine patients were evaluated with echocardiography and 3 of them required cardiological counseling. The cut-off value of 600 pg/mL was found to have the best sensitivity (73%, CI 95% 0.43–0.9), specificity (98%, CI 95% 0.95–0.98), positive likelihood ratio (29, CI 95% 12–69) and negative likelihood ratio (0.28, IC 95% 0.10–0.70). The diagnostic odds ratio was 104 (CI 95% 22–494, p