Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients.
OBJECTIVE
Peripartum cardiomyopathy (PPCM) is a disorder of unknown aetiology with a course and outcome that is largely unpredictable. We evaluated the prognostic role of multiple inflammatory markers in the plasma of a large cohort of African patients with PPCM.


RESULTS
The study of 100 patients with newly diagnosed PPCM was single-centred, prospective, and longitudinal. Clinical assessment, echocardiography, and blood analysis were done at baseline and after 6 months of standard therapy. Inflammatory markers were measured at baseline only. Fifteen patients died. Left ventricular ejection fraction (LVEF) improved from 26.2+/-8.2 to 42.9+/-13.6% at 6 months (P<0.0001). However, normalization of LVEF (>50%) was only observed in 23%. Baseline levels of C-reactive protein correlated positively with baseline LV end-diastolic (rs=0.33, P=0.0026) and end-systolic (rs=0.35, P=0.0012) diameters and inversely with LVEF (rs=-0.27, P=0.015). Patients who died presented with significantly lower mean EF and higher Fas/Apo-1 plasma values (P<0.05). Fas/Apo-1 and New York Heart Association functional class (NYHA FC) predicted mortality at baseline.


CONCLUSIONS
Plasma markers of inflammation were significantly elevated and correlated with increased LV dimensions and lower LVEF at presentation. Baseline Fas/Apo-1 and higher NYHA FC were the only predictors of mortality. Normalization of LVEF was only observed in 23% of this African cohort.
Sliwa
Karen
K
Department of Cardiology, Chris Hani Baragwanath Hospital, University of the Witwatersrand, PO Bertsham 2013, Johannesburg, South Africa. silwa-hahnlek@mdh-africa.org
Förster
Olaf
O
Libhaber
Elena
E
Fett
James D
JD
Sundstrom
Jay Bruce
JB
Hilfiker-Kleiner
Denise
D
Ansari
Aftab A
AA
D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000097:blood / Q000401:mortality / Q000473:pathology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000401:mortality* / Q000473:pathology; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D008137:Longitudinal Studies; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000097:blood / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D013019:South Africa / Q000453:epidemiology; D013318:Stroke Volume / Q000502:physiology; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000401:mortality / Q000473:pathology; D019014:fas Receptor / Q000378:metabolism*
D015415:Biomarkers; D014409:Tumor Necrosis Factor-alpha; D019014:fas Receptor; D002097:C-Reactive Protein