Introduction:
The contribution of obesity and metabolic syndrome to the development of peripartum cardiomyopathy (PPCM) remains unknown. Leptin is a peptide hormone released by adipose tissue which may mediate impact of the obesity on cardiovascular function. We sought to evaluate their effect on myocardial recovery in PPCM in the multicenter Investigation of Pregnancy Associated Cardiomyopathy (IPAC) study.
Methods:
100 women with new onset of PPCM were enrolled and serum obtained for biomarker analysis at entry. Myocardial function was assessed by echocardiography at entry, 2 months, 6 months and 12 months postpartum and LVEF calculated at a core lab. Leptin levels were measured by ELISA and the correlation of leptin with body mass index (BMI) and days post-partum evaluated. LVEF over the first year postpartum was compared by BMI at study entry (BMI >30 versus<=) and then compared by of Leptin levels (median).
Results:
The cohort was 30% black 65% white 5% other,age 30
+
6, mean BMI was 28.9
+
7.4 and LVEF 0.34
+
0.10 at study entry 31
+
25 days post-partum.Compared to those with a BMI<=30 women with a BMI > 30 had a similar LVEF at entry (LVEF BMI>30 vs
<
: 0.35
+
0.09 vs 0.34
+
0.10, p=0.60), but a lower LVEF at 2 month (0.39
+
0.12 vs 0.45
+
0.12, p=0.02), 6months (0.38
+
0.12 vs 0.53
+
0.09, p=0.02) and 12 months (0.50
+
0.13 vs 0.55
+
0.08, p=0.03). Leptin levels (mean 23.4
+
21.1 ng/ml, median 15.26 ng/ml) correlated with BMI (r=0.57, p<0.001). Higher leptin levels were associated with more remodeling (LVEDD for high/low leptin= 5.8
+
0.7/5.4
+
0.6, p=0.02) at entry and lower LVEF 2months (high/low= 0.40
+
0.12/ 0.46
+
0.11, p=0.02) which persisted at 12 months (high/low= 0.51
+
0.11/0.56
+
0.08, p=0.03). Leptin levels were significantly lower at entry in subjects who subsequently recovered to an LVEF>=0.50 (19.2
+
19.1 vs 31.8
+
22.9, p=0.006), and were higher in diabetics (p=0.01) and in blacks (p=0.03).
Conclusions:
In women with PPCM, obesity was associated with a lower LVEF at 6 and 12 months. Leptin levels correlated with BMI and were associated with greater LV remodeling at presentation and lower LVEF at 12 months. The impact of obesity and leptin on the development of cardiomyopathy warrants further investigation.
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