Five-year prognosis of life in patients with peripartum cardiomyopathy

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OBJECTIVE

To study the features of course and prognosis of life in patients with peripartum cardiomyopathy (PCMP) over a 5-year follow-up period.

MATERIAL AND METHODS

The study included 51 patients with PPCM who underwent standard examination. Patients were divided into several groups depending on 5-year outcomes: group 1 — normalization of LVEF (> 50%) and no clinical signs of heart failure; group 2 — death due to progression of heart failure (HF) or sudden cardiac death (SCD), group 3 — patients with echocardiography data abnormalities (enlarged heart chambers, LVEF <50%).

RESULTS

Normalization of LVEF was observed in 22 (43%) women. After a year, mortality from heart failure progression was 5% (n=3). SCD occurred in 1 case. Within 2 years, 3 patients died due to progression of heart failure. Overall mortality was 11% (n=6). Overall 5-year mortality was 24% (n=12), where SCD was established only in 3 cases (one patient after repeated birth within a year after onset of disease). Age of patients, high heart rate and hemoglobin were not significant predictors in patients with PPCM. There was a higher baseline tolerance to physical activity in the 1^st group. The worst echocardiography parameters were noted in patients with fatal outcomes (LV EDD 67.7±8.1 and 66.7±5.8 in groups 2 and 3, respectively, p<0.05). In the same groups, incidence of left bundle branch block (LBBB) was 33.3%, no R or Q-S wave was recorded in 58.3% of cases.

CONCLUSION

Patients with unfavorable course of disease (exitus letalis or persistent heart failure) are characterized by low functional status and severe LV systolic dysfunction. ECG changes (LBBB and no R wave) were more common in deceased patients.

Keywords:

peripartum cardiomyopathy

heart failure

prognosis

Authors:

Tsoi I.A.

Republican Specialized Scientific Practical Medical Center of Cardiology

Abdullaev T.A.

Republican Specialized Scientific Practical Medical Center of Cardiology

Khudoyberganov O.K.

Republican Specialized Scientific Practical Medical Center of Cardiology

Mirzarakhimova S.T.

Republican Specialized Scientific Practical Medical Center of Cardiology

Received:

12.04.2022

Accepted:

01.08.2022

List of references:

Cantwell R, Clutton-Brock T, Cooper G, et al. Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer: 2006—2008. International Journal of Obstetrics & Gynaecology. 2011;118(suppl 1):1-203. https://doi.org/10.1111/j.1471-0528.2010.02847.x
Mocumbi AO, Sliwa K, Soma-Pillay P. Medical disease as a cause of maternal mortality: the pre-imminence of cardiovascular pathology. Cardiovascular Journal of Africa. 2016;27(2):84-88. https://doi.org/10.5830/CVJA-2016-018
Johnson-Coyle L, Jensen L, Sobey A. Peripartum cardiomyopathy: review and practice guidelines. American Journal of Critical Care. 2012;21(2):89-98. https://doi.org/10.4037/ajcc2012163
Elkayam U, Goland S, Pieper PG, Silversides CK. High-Risk Cardiac Disease in Pregnancy: Part II. Journal American College of Cardiology. 2016;68(5):502-516. https://doi.org/10.1016/j.jacc.2016.05.050
Kolte D, Khera S, Aronow WS, Palaniswamy C, Mujib M, Ahn C, Jain D, Gass A, Ahmed A, Panza JA, Fonarow GC. Temporal trends in incidence and outcomes of peripartum cardiomyopathy in the United States: a nationwide population-based study. Journal American Heart Association. 2014;3(3):e001056. https://doi.org/10.1161/JAHA.114.001056
Hilfiker-Kleiner D, Sliwa K. Pathophysiology and epidemiology of peripartum cardiomyopathy. Nature Reviews Cardiology. 2014;11(6):364-370. https://doi.org/10.1038/nrcardio.2014.37
Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, Regitz-Zagrosek V, Schaufelberger M, Tavazzi L, van Veldhuisen D J, Watkins H, Shah A J, Seferovic PM, Elkayam U, Pankuweit S, Papp Z, Mouquet F, McMurray JJV. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. European Journal of Heart Failure. 2010;12(8):767-778. https://doi.org/10.1093/eurjhf/hfq120
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; ESC Scientific Document Group 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal. 2016;37(27):2129-2200. https://doi.org/10.1093/eurheartj/ehw128
Duran N, Günes H, Duran I, Biteker M, Özkan M. Predictors of prognosis in patients with peripartum cardiomyopathy. International Journal of Obstetrics & Gynaecology. 2008;101(2):137-140. https://doi.org/10.1016/j.ijgo.2007.11.007
Mahowald MK, Basu N, Subramaniam L, Scott R, Davis MB. Long-term Outcomes in Peripartum Cardiomyopathy. The Open Cardiovascular Medicine Journal. 2019;13:13-23. https://doi.org/10.2174/1874192401913010013
Akil MA, Bilik MZ, Yildiz A, Acet H, Ertas F, Simsek H, Polat N, Zengin H, Akilli R, Agacayak E, Kayan F, Ozdemir M, Alan S. Peripartum cardiomyopathy in Turkey: Experience of three tertiary centres. Journal of Obstetrics and Gynaecology. 2016;36(5):574-580. https://doi.org/10.3109/01443615.2015.1107531
Sliwa K, Förster O, Libhaber E, Fett JD, Sundstrom JB, Hilfiker-Kleiner D, Ansari AA. Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients. European Heart Journal. 2006;27(4):441-446. https://doi.org/10.1093/eurheartj/ehi481
McNamara DM, Elkayam U, Alharethi R, Damp J, Hsich E, Ewald G, Modi K, Alexis JD, Ramani GV, Semigran MJ, Haythe J, Markham DW, Marek J, Gorcsan J 3rd, Wu WC, Lin Y, Halder I, Pisarcik J, Cooper LT, Fett JD; IPAC Investigators Clinical Outcomes for Peripartum Cardiomyopathy in North America: Results of the IPAC Study (Investigations of Pregnancy-Associated Cardiomyopathy). Journal of the American College of Cardiology. 2015;66(8):905-914. https://doi.org/10.1016/j.jacc.2015.06.1309
Richardson P, McKenna W, Bristow M, Maisch B, Mautner B, O’Connell J, Olsen E, Thiene G, Goodwin J, Gyarfas I, Martin I, Nordet P. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of Cardiomyopathies. Circulation. 1996;93(5):841-842. https://doi.org/10.1161/01.cir.93.5.841
Fett JD, Sundstrom BJ, King ME, Ansari AA. Mother-daughter peripartum cardiomyopathy. International Journal of Cardiology. 2002;86(2-3):331-332. https://doi.org/10.1016/s0167-5273(02)00357-1
Fett JD, Sannon H, Thélisma E, Sprunger T, Suresh V. Recovery from severe heart failure following peripartum cardiomyopathy. International Journal of Obstetrics & Gynaecology. 2009;104(2):125-127. https://doi.org/10.1016/j.ijgo.2008.09.017
Kass DA. Ventricular remodelling: Chamber dyssynchrony and effects of cardiac resynchronization. European Heart Journal. 2004;6(9):I54-I63.
Honigberg MC, Elkayam U, Rajagopalan N, Modi K, Briller JE, Drazner MH, Wells GL, McNamara DM, Givertz MM. IPAC Investigators Electrocardiographic findings in peripartum cardiomyopathy. Clinical Cardiology. 2019;42(5):524-529. https://doi.org/10.1002/clc.23171

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