Clinical Observation of Peripartum Cardiomyopathy

ABSTRACT

BACKGROUND AND OBJECTIVES: Peripartum cardiomyopathy (PPCM) is a rare form of heart failure affecting women between the last month of pregnancy and the first five months after delivery. The etiology and prognostic factors of PPCM remains poorly understood, although some risk factors have been described. SUBJECTS AND METHODS: In order to characterize the features of PPCM, clinical and echocardiographic data, obtained from 19 patients who fulfilled diagnostic criteria of PPCM, from January 1996 to march 2001, were retrospectively analyzed. We divided the sample into 2 groups, which were classified according to clinical and echocardiographic improvements. (Group I; patients who improved, Group II; patients who did not improved, or deteriorated). RESULTS: Patients with PPCM (n=19, age 32+/-5 yrs, NYHA Class II-IV, LVEF 34.1+/-8.8%, follow-up period 14.2+/-16.3 months) had a high frequencies of the following clinical factors Anaemia (16/19, 84.2%); Pre-eclampsia (11/19, 57.9%); Multiparity (11/19, 57.9%); aged over 30 yrs old at delivery (11/19, 57.9%). During follow up, 10 patients improved to NYHA Class I, 8 patients failed to improve, or deteriorated, and 1 patient died due to ventricular fibrillation. Group II (n=9, age 31+/-3 yrs, follow up LVEF 38.8+/-12.9%), as compared to Group I (n=10, age 33+/-6 yrs, follow up LVEF 56.4+/-6.4%), had greater left ventricular end-systolic dimension (LVESD, 53.0+/-7.7 mm vs 45.9+/-4.8 mm; p<0.05). CONCLUSION: PPCM has a high rate of progression to dilated cardiomyopathy. Therefore, in pregnant women with common clinical findings of PPCM, including anemia, pre-eclampsia, multiparity and old age at delivery, the initial echocardiographic assessment for cardiac function is essential, and serial follow-up is required.