title: Short and long-term outcome of pregnant women with preexisting dilated cardiomypathy: an NTproBNP and echocardiography-guided study.
abstract: BACKGROUND
  Little is known of the outcome of pregnant patients with previously diagnosed dilated cardiomyopathy. These patients are usually firmly advised against continuation of the pregnancy.
  
  
  OBJECTIVE
  To examine the usefulness of serial echocardiographic follow-up and plasma N-terminal pro-B type natriuretic peptide levels in the management of pregnant women with preexisting DCM.
  
  
  METHODS
  We prospectively enrolled pregnant women with DCM either known or diagnosed in the first trimester. Clinical examination and serial echocardiography studies were performed at baseline, at 30 weeks gestation, peripartum, and 3 and 18 months postpartum. Blinded NTproBNP levels were obtained at 30 weeks, at delivery and 3 months postpartum.
  
  
  RESULTS
  Between June 2005 and October 2006 we enrolled seven women who fulfilled the study criteria. Delivery and postpartum were complicated in 3 patients (42%): 2 with acute heart failure, which resolved conservatively, and 1 with major pulmonary embolism. The left ventricular ejection fraction was stable throughout the pregnancy (35% +/- 2.8 at baseline, 33% +/- 2.9 at 30 weeks) and postpartum (35% +/- 2.8 at 1 day, 34% +/- 3.1 at 90 days). Similar stable behavior was observed regarding left ventricular dimensions: LV end-systolic diameters 43.3 +/- 2.7 mm and LV end-diastolic diameters 57.3 +/- 3.3 mm at baseline compared with 44.1 +/- 3.1 mm and 58.7 +/- 3.1 mm postpartum, respectively. The NTproBNP levels rose significantly peripartum in all three patients with complications.
  
  
  CONCLUSIONS
  Serial NTproBNP levels, as compared to echocardiography, may be a better clinical tool in monitoring and management of pregnant women with preexisting DCM. An early rise in NTproBNP level appears to predict the occurrence of adverse events.
authors.affiliation: Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel. alexb@asaf.health.gov.il
authors.forename: Alex
authors.initials: A
authors.lastname: Blatt
authors.forename: Ran
authors.initials: R
authors.lastname: Svirski
authors.forename: Gil
authors.initials: G
authors.lastname: Morawsky
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.forename: Ortal
authors.initials: O
authors.lastname: Neeman
authors.forename: Dan
authors.initials: D
authors.lastname: Sherman
authors.forename: Zvi
authors.initials: Z
authors.lastname: Vered
authors.forename: Ricardo
authors.initials: R
authors.lastname: Krakover
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000097:blood* / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D058725:Peripartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000097:blood* / Q000000981:diagnostic imaging* / Q000628:therapy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain