title: Risk stratification of women with peripartum cardiomyopathy at initial presentation: a dobutamine stress echocardiography study.
abstract: OBJECTIVE
  We sought to determine the prognostic use of inotropic contractile reserve on risk stratification and prognostication of women with peripartum cardiomyopathy.
  
  
  BACKGROUND
  Peripartum cardiomyopathy is a rare disorder effecting women in their prime years of life. There appears to be an initial high-risk period with 25% to 50% of women dying within the first 3 months postpartum. Early risk stratification and prognostication are, thus, crucial. However, only limited data are available.
  
  
  METHODS
  In all, 7 women (mean age 31.8 years) with peripartum cardiomyopathy and severe left ventricular (LV) dysfunction (mean LV ejection fraction [LVEF] 25.3 +/- 9.5%) were studied. Of these, 6 underwent dobutamine stress echocardiography at baseline and a follow-up resting echocardiogram at a mean of 4.7 +/- 0.9 months after initial presentation. Resting and peak inotropic contractile reserve, and follow-up LVEF, were computed.
  
  
  RESULTS
  The mean LVEF improved significantly from baseline (25.3 +/- 9.5%) to maximal inotropic contractile reserve (53.8 +/- 12.6%) (P = .0004) and at follow-up (53.0 +/- 16.4%) (P = .006). Importantly, LVEF at maximal inotropic contractile reserve and at follow-up (5.6 months) did not differ significantly (P = .5). The mean LVEF at maximal inotropic contractile reserve correlated well with the follow-up (LVEF R = 0.79). However, the baseline LVEF did not correlate with follow-up LVEF (P = not significant).
  
  
  CONCLUSIONS
  In patients presenting with peripartum cardiomyopathy, inotropic contractile reserve during dobutamine stress echocardiography accurately correlates with subsequent recovery of LV function and confers a benign prognosis.
authors.affiliation: Division of Cardiology, Department of Medicine, Hahnemann University Hospital, Philadelphia, Pennsylvania.
authors.forename: Sharmila
authors.initials: S
authors.lastname: Dorbala
authors.forename: Susan
authors.initials: S
authors.lastname: Brozena
authors.forename: Sophia
authors.initials: S
authors.lastname: Zeb
authors.forename: Kathleen
authors.initials: K
authors.lastname: Galatro
authors.forename: Peter
authors.initials: P
authors.lastname: Homel
authors.forename: Jian-Fang
authors.initials: JF
authors.lastname: Ren
authors.forename: Farooq A
authors.initials: FA
authors.lastname: Chaudhry
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000503:physiopathology; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D009200:Myocardial Contraction; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011379:Prognosis; D018570:Risk Assessment; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology