Pregnancy and peripartum cardiomyopathy: a comparative and prospective study

Abstract

Objective -To assess pregnancy outcome in women with peripartum cardiomyopathy and to compare it with idiopathic cardiomyopathy. Peripartum cardiomyopathy is a rare disease of unknown cause that affects women of reproductive age. Its incidence is related to the peripartum period. Hypotheses of its cause are focused on the physiologic relationship between pregnancy and the postpartum period and infective genetic disorders and hormonal and metabolic changes [1][2][3] . The criteria for diagnosis of peripartum cardiomyopathy include heart failure in the last month of pregnancy or within the first 5 postpartum months, in the absence of a determinable cause of cardiac failure or the absence of demonstrable preexisting heart disease 4 , and systolic dysfunction confirmed by a lower ejection fraction (EF) or the left ventricular fractional shortening, or both of these, shown by echocardiographic measurement 5 . Studies [6][7][8] about the natural cause of peripartum cardiomyopathy estimate that more than half of these patients experience a regression in ventricular dysfunction, while about 25% evolve to death within 3 months due to heart failure, arrhythmias, or thromboembolism and the remaining patients develop dilated cardiomyopathy. Methods -No consensus, therefore, exists regarding recommendations for future pregnancies in women who have peripartum cardiomyopathy. The persistence of ventricular dysfunction is associated with a high risk of complications and maternal death. On the other hand, the recovery of ventricular function does not assure a good prognosis of the next pregnancy, in addition to the hypotheses about the recurrence of the disease, decreased EF, and heart failure in the peripartum period 9,10 . We undertook a study to evaluate the clinical and obstetric evolvement of pregnancy in women with a previous diagnosis of peripartum cardiomyopathy, to evaluate the factors associated with its prognosis, and to compare it with the evolvement of patients with idiopathic dilated cardiomyopathy. MethodsFrom 1990 to 1998, 26 pregnant women were followed. All had dilated cardiomyopathy discovered during routine

Asymptomatic left ventricular dysfunction in puerperal women: An echocardiographic-based study

“…The natural history of peripartum cardiomyopathy was described in cohort studies that followed up patients with clear signs and symptoms of this condition [1,[9][10][11][12][19][20][21][22][23]. However, the occurrence of asymptomatic ventricular dysfunction associated with puerperium remains relatively understudied.…”

Pregnancy in Patients With Pre-Existing Cardiomyopathies

“…None of the dilated cardiomyopathy patients had a significant decline in cardiac status. In contrast, a study of 26 women from Brazil suggested that cardiac complications were higher in the idiopathic cardiomyopathy cohort when compared with those with persistent left ventricular dysfunction due to peripartum cardiomyopathy (45). A study from Haiti identified 99 women with peripartum cardiomyopathy, 15 of whom had subsequent pregnancies.…”

Peripartum cardiomyopathy: A comprehensive review

“…Currently, there is no consensus regarding recommendations for future pregnancy after PPCM, but left ventricular function is considered the most important prognostic factor and must be the most parameter when counseling patients with PPCM about a new pregnancy [144].…”