Long-term outcome of peripartum cardiomyopathy in a population with high seropositivity for human immunodeficiency virus.
BACKGROUND
Peripartum cardiomyopathy (PPCM) is a rare cardiomyopathy with a high risk of mortality. The present study assessed clinical outcome and mortality over a 2-year period in an African cohort of 80 PPCM patients.


METHODS
A prospective study over a 2-year period at a tertiary center, where 80 consecutive women presenting with PPCM were enrolled on first diagnosis. Patients obtained standard heart failure therapy. Detailed assessments included echocardiography, NYHA functional class, left ventricular ejection fraction (LVEF), mortality and serum levels for hemoglobin, CRP, IL-6, TNF-alpha, Fas/Apo-1, and T-cell count at each 6-month intervals for 24 months.


RESULTS
Baseline mean age was 30 ± 7 years; 38% were primigravidas and 34% were co-infected with HIV. NYHA functional class III-IV was present in 89% patients with a mean LVEF of 30 ± 9%. Four patients were lost to follow-up, 9 moved to remote areas, 7 were excluded due to subsequent pregnancy. The 2-year mortality rate was 28%. Eight of 80 (10%) died by 6 months. Mean LVEF of surviving patients was: 44 ± 11% at 6-months, 46 ± 13% at 12-months and 50 ± 14% at 24-months follow-up. Of the 69 patients still enrolled at 6 months 14 (20%) died over the remaining 18-month period, despite functional recovery. No statistically significant difference in LVEF and mortality was observed between PPCM patients with or without HIV co-infection.


CONCLUSIONS
The novel finding of this study is the continuous high mortality of PPCM patients occurring beyond 6 months independent of HIV infection and subsequent pregnancy. This finding strongly encourages the need for long-term clinical follow-up and management of women with PPCM.
Sliwa
Karen
K
Soweto Cardiovascular Research Unit, Department of Cardiology, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa. sliwa-hahnlek@mdh-africa.org
Forster
Olaf
O
Tibazarwa
Kemi
K
Libhaber
Elena
E
Becker
Anthony
A
Yip
Anthony
A
Hilfiker-Kleiner
Denise
D
D000328:Adult; D044383:Black People / Q000706:statistics & numerical data*; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000401:mortality*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000401:mortality*; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality; D006801:Humans; D058725:Peripartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging / Q000401:mortality*; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult