OBJECTIVE: The objective of the study was to assess the prognostic value of ejection fraction (EF) at index and subsequent pregnancy on long-term outcome in patients with peripartum cardiomyopathy (PPCM). STUDY DESIGN: Seventy PPCM patients met inclusion criteria. Patients had echocardiography evaluations at the index pregnancy, at interval follow-up (F/U) or at the beginning of a subsequent pregnancy and the last F/U study available. Outcome data were echocardiographic parameters and the subsequent need for cardiac transplant. RESULTS: Patients were categorized on the basis of their initial EF into EF of 25% or less and EF greater than 25% and stratified on the basis of their pregnancy into the following groups: group 1 (n = 33), no subsequent pregnancy; group 2 (n = 16), subsequent pregnancy with early termination; and group 3 (n = 21), successful subsequent pregnancy. F/U from index pregnancy to final F/U was 3.4+/-1.9 (range, 1-6 years). Groups 1 and 2 had persistent left ventricular dysfunction at all echocardiographic evaluations. In group 3, despite a mean EF greater than 40% at a subsequent pregnancy, 29% had worsening cardiac symptoms. Among 28 patients with EF of 25% or less, 16 (57%) had end-stage cardiac disease. One had a transplant and 15 were on a transplant list. All 16 had a baseline EF 25% or less at index pregnancy: 4 had improved (EF greater than 40%) at interval F/U and 3 at last F/U available. CONCLUSION: Women with a history of PPCM had a higher rate of progression of symptoms of heart failure in a subsequent pregnancy. A baseline left ventricular EF 25% or less at index pregnancy is associated with a higher rate of cardiac transplant.
OBJECTIVE: The objective of the study was to assess the prognostic value of ejection fraction (EF) at index and subsequent pregnancy on long-term outcome in patients with peripartum cardiomyopathy (PPCM). STUDY DESIGN: Seventy PPCM patients met inclusion criteria. Patients had echocardiography evaluations at the index pregnancy, at interval follow-up (F/U) or at the beginning of a subsequent pregnancy and the last F/U study available. Outcome data were echocardiographic parameters and the subsequent need for cardiac transplant. RESULTS:Patients were categorized on the basis of their initial EF into EF of 25% or less and EF greater than 25% and stratified on the basis of their pregnancy into the following groups: group 1 (n = 33), no subsequent pregnancy; group 2 (n = 16), subsequent pregnancy with early termination; and group 3 (n = 21), successful subsequent pregnancy. F/U from index pregnancy to final F/U was 3.4+/-1.9 (range, 1-6 years). Groups 1 and 2 had persistent left ventricular dysfunction at all echocardiographic evaluations. In group 3, despite a mean EF greater than 40% at a subsequent pregnancy, 29% had worsening cardiac symptoms. Among 28 patients with EF of 25% or less, 16 (57%) had end-stage cardiac disease. One had a transplant and 15 were on a transplant list. All 16 had a baseline EF 25% or less at index pregnancy: 4 had improved (EF greater than 40%) at interval F/U and 3 at last F/U available. CONCLUSION:Women with a history of PPCM had a higher rate of progression of symptoms of heart failure in a subsequent pregnancy. A baseline left ventricular EF 25% or less at index pregnancy is associated with a higher rate of cardiac transplant.
Authors: Jonathan G Howlett; Robert S McKelvie; Jeannine Costigan; Anique Ducharme; Estrellita Estrella-Holder; Justin A Ezekowitz; Nadia Giannetti; Haissam Haddad; George A Heckman; Anthony M Herd; Debra Isaac; Simon Kouz; Kori Leblanc; Peter Liu; Elizabeth Mann; Gordon W Moe; Eileen O'Meara; Miroslav Rajda; Samuel Siu; Paul Stolee; Elizabeth Swiggum; Shelley Zeiroth Journal: Can J Cardiol Date: 2010-04 Impact factor: 5.223
Authors: Dhaval Kolte; Sahil Khera; Wilbert S Aronow; Chandrasekar Palaniswamy; Marjan Mujib; Chul Ahn; Diwakar Jain; Alan Gass; Ali Ahmed; Julio A Panza; Gregg C Fonarow Journal: J Am Heart Assoc Date: 2014-06-04 Impact factor: 5.501