Five-year prospective study of the incidence and prognosis of peripartum cardiomyopathy at a single institution.
OBJECTIVE
To determine the incidence and prognosis of peripartum cardiomyopathy (PPCM) in rural Haiti.


METHODS
Prospectively identified patients with PPCM treated at the Hospital Albert Schweitzer (HAS), Deschapelles, Haiti, were included in this study. Patients who presented to HAS from February 1, 2000, to January 31, 2005, were identified through a search of the HAS PPCM Registry. Clinical and serial echocardiographic data were collected on these patients.


RESULTS
The 5-year experience confirms the high incidence of PPCM in this area, approximately 1 case per 300 live births, which is severalfold the estimated incidence in the United States (estimated 1 case per 3000 to 4000 live births). In this population, the ratio of PPCM deaths for the 5-year period was 47.1 per 100,000 births compared with the US ratio of 0.62 per 100,000 births. The mortality rate was 15.3% (15 deaths of 98 patients), and the mean follow-up was 2.2 years (range, 1 month to 5 years). Five years after the initiation of the HAS PPCM Registry search, 26 (28%) of 92 patients with PPCM observed for at least 6 months had regained normal left ventricular function. The difference in left ventricular echocardiographic features at diagnosis between deceased patients and survivors was not statistically significant: mean end-diastolic dimension (6.2 vs 5.8 cm; P=.08), ejection fraction (22% vs 25%; P=.12), and fractional shortening (16% vs 15%; P=.46). Left ventricular echocardiographic features at diagnosis were unable to predict individually who would eventually recover, although a statistically significant difference occurred at diagnosis between the recovered group and nonrecovered group for mean ejection fraction (28% vs 23%; P<.001) and fractional shortening (17% vs 14%; P=.004).


CONCLUSIONS
Peripartum cardiomyopathy occurs significantly more commonly in rural Haiti on a per capita basis than in the United States. Patients with PPCM have a higher mortality rate and a poorer return of normal ventricular function.
Fett
James D
JD
Department of Adult Medicine, Hôpital Albert Schweitzer, Deschapelles, Haiti. jdftlsc@techline.com
Christie
Len G
LG
Carraway
Robert D
RD
Murphy
Joseph G
JG
D000293:Adolescent; D000328:Adult; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006205:Haiti / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000453:epidemiology*; D011263:Pregnancy Trimester, Third; D011379:Prognosis; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D012423:Rural Health; D015996:Survival Rate; D013997:Time Factors