Elsevier

American Heart Journal

Volume 152, Issue 3, September 2006, Pages 509-513
American Heart Journal

Clinical Investigation
Congestive Heart Failure
Improved outcomes in peripartum cardiomyopathy with contemporary

This study was presented in part at the Heart Failure Society of America 2004 Annual Meeting.
https://doi.org/10.1016/j.ahj.2006.02.008Get rights and content

Background

Prior studies have shown both high morbidity and mortality for patients with peripartum cardiomyopathy (PPCM). These studies were small and predated current advances in heart failure treatment. We sought to determine the outcomes of women with PPCM in the contemporary era and to determine predictors of poor outcome.

Methods

Patients with PPCM from 1990 to 2003 were identified retrospectively through screening of heart failure clinics and echocardiography records. Their records were reviewed, and current clinical status was determined.

Results

Fifty-five patients were identified with an average follow-up of 43 months. Their mean initial ejection fraction (EF) was 20%. Compared with their initial EF, 62% of patients improved, 25% were unchanged, and 4% declined. No patients died, and 10% eventually required transplant. At 2 months after diagnosis, 75% of those who eventually recovered had an EF >45%. Factors associated with lack of recovery at initial assessment were a left ventricular (LV) end-diastolic dimension >5.6 cm, the presence of LV thrombus, and African-American race. Recovery of LV function was not predicted by the initial EF. Among patients who recovered, the withdrawal of heart failure medications was not associated with decompensation over a follow-up of 29 months.

Conclusions

The morbidity related to PPCM is less than previously reported. Initial LV end-diastolic dimension and EF at 2 months predict long-term outcomes. The discontinuation of heart failure medications after recovery did not lead to decompensation.

Section snippets

Methods

All patients with PPCM at Duke University Medical Center between January 1990 and December 2003 were identified by reviewing the echocardiography database and the records from the congestive heart failure clinics. Clinical and demographical data (including age, number of pregnancies, medical history, medical therapy, and EF) were collected by review of medical records. Patients were also contacted by telephone to update their current clinical status.

To be eligible for the study, patients had to

Results

Fifty-five patients with PPCM were identified and followed up for 43 ± 43 months. Baseline characteristics are shown in Table I. The mean age was 29 ± 6 years. Fifty-one percent of the patients were African American, and 39% were white. Half of the patients underwent cesarean section, usually because of a history of eclampsia or preeclampsia (46%). A history of hypertension was found in 56%, and 39% had a history of tobacco abuse. The baseline EF was 20.5 %, and 17% had a LV thrombus on their

Discussion

This is the largest study to date describing a population of women with PPCM and the first to describe outcomes in the contemporary era of heart failure therapy. Similar to 2 previous studies, this study demonstrates that on proper medical therapy, the current clinical outcome of PPCM is better than previously described.5, 14 There were no deaths over an average of 43 months, and only 10% required heart transplantation. The lack of deaths was, in part, due to the use of LV assist devices to

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