title: Peripartum cardiomyopathy: a longitudinal echocardiographic study.
abstract: OBJECTIVE
  Our purpose was to determine echocardiographic trends after initial diagnosis of peripartum cardiomyopathy.
  
  
  METHODS
  Nine women diagnosed with peripartum cardiomyopathy were prospectively recruited for a longitudinal echocardiographic study. Severe myocardial dysfunction was defined as left ventricular end-diastolic dimension > or = 60 mm + fractional shortening < or = 21%, and mild dysfunction was defined as left ventricular end-diastolic dimension < 60 mm + fractional shortening 22% to 24%. Unpaired t tests were used to compare sample means and Fisher's exact test used to compare discrete variables.
  
  
  RESULTS
  All women were seen initially for pulmonary edema. Echocardiography showed decreased systolic function in all women. The mean age at diagnosis was 33.0 +/- 6.9 years. All but one woman had a diagnosis of either chronic hypertension (n = 6) or preeclampsia (n = 2). Four women were first seen ante partum and five post partum (range 1 day to 2 months). Repeat echocardiography was performed in all nine women (median 8 months, range 6 weeks to 5 years). There was no correlation between antepartum or postpartum presentation and cardiovascular status on follow-up (p = 0.3). Values for initial left ventricular end-diastolic dimension, severe versus mild dysfunction (68.3 +/- 7.2 mm vs 55.0 +/- 4.2 mm, p = 0.046), follow-up left ventricular end-diastolic dimension, severe versus mild (68.7 +/- 4.1 mm vs 52.0 +/- 5.7 mm, p = 0.002), and follow-up fractional shortening, severe versus mild (14.6% +/- 5.0% vs 28.5% +/- 9.2%, p = 0.02) are significant. Six of the seven women with severe dysfunction had stable disease in follow-up and one is awaiting heart transplant. One of the two women with mild dysfunction had disease resolution and one had stable disease.
  
  
  CONCLUSIONS
  Patients with severe myocardial dysfunction due to peripartum cardiomyopathy are unlikely to regain normal cardiac function on follow-up.
authors.affiliation: Department of Obstetrics and Gynecology, University of Tennessee, Memphis, USA.
authors.forename: A G
authors.initials: AG
authors.lastname: Witlin
authors.forename: W C
authors.initials: WC
authors.lastname: Mabie
authors.forename: B M
authors.initials: BM
authors.lastname: Sibai
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D011247:Pregnancy; D011644:Puerperal Disorders / Q000000981:diagnostic imaging* / Q000503:physiopathology