Predictors of Prognosis in Patients With Peripartum Cardiomyopathy

Abstract

condition, alcohol intake, drug abuse, or family history of preeclampsia made significant independent contribution in predicting cardiac output in the multiple regression model. The mean log MoM cardiac output was 0.000 [95% confidence interval (CI): À 0.0025 to 0.0025] in the unaffected group, 0.0261 (95% CI: 0.0065-0.0457) in the preeclampsia group, 0.0257 (95% CI: 0.0079-0.0435) in the PIH group, and -0.0085 (95% CI: À 0.0157 to À 0.0013) in the SGA group. In the patients with preeclampsia, log MoM cardiac output increased significantly with birth weight percentile (r = 0.346, P<0.001), with mean values of 0.0382 (95% CI: 0.0108-0.0656) in the preeclampsia group without SGA and 0.0111 (95% CI: À 0.0174 to 0.0396) in the preeclampsia group with SGA, respectively. Compared with the unaffected population, the mean log MoM cardiac output was higher in the preeclampsia group (P = 0.01), preeclampsia without SGA group (P = 0.008), and in the PIH group (P = 0.003). The statistic was lower in the SGA group (P = 0.03), and not significantly different in preeclampsia with SGA (P = 0.44). Significant prediction for SGA was provided by lower log MoM cardiac output [odds ratio (OR): 0.29; 95% CI: 0.09-0.92], smoking (OR: 3.1; 95% CI: 2.4-4.1), b-mimetic medication (OR: 2.9; 95% CI: 1.7-5.4), crown-rump length (OR: 0.97; 95% CI: 0.96-0.99), and ethic origin. Areas under receiver operating characteristics curves were 0.813, 0.830, 0.630, and 0.629 for all preeclampsia, preeclampsia without SGA, PIH, and SGA. For a 10% false-positive rate, the respective true positive rates were 43.4%, 52.2%, 23.3%, and 23.9%.Compared with values in women who go on to have uncomplicated pregnancies, maternal cardiac output, as measured by echocardiography at 11 to 13 weeks' gestation, is increased in pregnancies that go on to be complicated by preeclampsia. Cardiac output at 11 to 13 weeks is decreased in women who subsequently deliver SGA infants. These changes predate the clinical onset of both disorders.

Recovery from peripartum cardiomyopathy after treatment with bromocriptine

“…Duran et al [3] very recently published a report suggesting that persistent left ventricular dysfunction is probable in PPCM patients with LVEDd N 55 mm and LVEF ≤ 27%. Both of these criteria were applicable to our patient.…”

“…The origins of this disease were unknown until recently, and thus treatment was empirical and restricted to standard heart failure therapy with ACE-inhibitors, beta-blockers, diuretics, aldosterone antagonists and, in most severe cases, biventricular assist systems or heart transplantation. The prognosis of PPCM is controversial, but a left ventricular ejection fraction (LVEF) below 27% is associated with a mortality of between 9 and 30% [2,3]. According to a new pathophysiological explanation reported recently by Hilfiker-Kleiner et al, a 16 kDa form of the post-partally upregulated hormone prolactin initiates cell apoptosis and disrupts capillaries, thus inducing myocardial damage and heart failure [4].…”

Peripartum Cardiomyopathy: A Systematic Review

“…Electrocardiogram is seldom normal in patients with heart failure caused by PPCM, but it is mostly non-specific. Sinus rhythm or sinus tachycardia are usually present, atrial fibrillation or ventricular tachycardia may occur, particularly if LV systolic dysfunction becomes chronic (Diao, 2004;Duran, 2008). An intraventricular block pattern or prolonged PR and QRS are seldom reported.…”

“…Hibbard et al proposed precise echocardiographic criteria that should be applied ( Table 2). Several studies highlighted the strong relation between LV end-diastolic diameter > 60 mm, or ejection fraction < 30% and the recovery of LV function (Duran, 2008;Elkayam, 2005). Another important finding may be the presence of LV thrombus, particularly when LV function is severely depressed.…”

Contemporary Views on Peripartum Cardiomyopathy — Clinical Picture, Diagnostics, Course, Treatment (Part Ii)

“…Достаточно часто (до 50% случаев) у таких боль-ных развивается блокада левой ножки пучка Гиса [26]. S. Labidi et al (2011), наблюдавшие такую бло-каду при ПКМП, полагают, что её появление следует рассматривать в качестве первого признака дебюта обсуждаемой патологии [27].…”