Improved outcomes in peripartum cardiomyopathy with contemporary.
BACKGROUND
Prior studies have shown both high morbidity and mortality for patients with peripartum cardiomyopathy (PPCM). These studies were small and predated current advances in heart failure treatment. We sought to determine the outcomes of women with PPCM in the contemporary era and to determine predictors of poor outcome.


METHODS
Patients with PPCM from 1990 to 2003 were identified retrospectively through screening of heart failure clinics and echocardiography records. Their records were reviewed, and current clinical status was determined.


RESULTS
Fifty-five patients were identified with an average follow-up of 43 months. Their mean initial ejection fraction (EF) was 20%. Compared with their initial EF, 62% of patients improved, 25% were unchanged, and 4% declined. No patients died, and 10% eventually required transplant. At 2 months after diagnosis, 75% of those who eventually recovered had an EF >45%. Factors associated with lack of recovery at initial assessment were a left ventricular (LV) end-diastolic dimension >5.6 cm, the presence of LV thrombus, and African-American race. Recovery of LV function was not predicted by the initial EF. Among patients who recovered, the withdrawal of heart failure medications was not associated with decompensation over a follow-up of 29 months.


CONCLUSIONS
The morbidity related to PPCM is less than previously reported. Initial LV end-diastolic dimension and EF at 2 months predict long-term outcomes. The discontinuation of heart failure medications after recovery did not lead to decompensation.
Amos
Ankie M
AM
Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
Jaber
Wissam A
WA
Russell
Stuart D
SD
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors