title: Evaluation of the clinical relevance of baseline left ventricular ejection fraction as a predictor of recovery or persistence of severe dysfunction in women in the United States with peripartum cardiomyopathy.
abstract: BACKGROUND
  Baseline left ventricular ejection fraction (LVEF) has been shown to be associated with likelihood of recovery in patients with peripartum cardiomyopathy (PPCM). The clinical relevance of this association for individual patients is unclear.
  
  
  RESULTS
  We analyzed baseline parameters of LVEF in 187 PPCM patients with ≥6 months follow-up data in an attempt to detect the value of baseline LVEF as a predictor of early recovery or persistence of severe LV dysfunction. Recovery of LV function (LVEF ≥50%) at 6 months after diagnosis was found in 115 patients (61%). Multivariate analysis identified baseline LVEF >30% as a significant predictor for recovery (odds ratio 5.2, 95% confidence interval 1.96-7.70; P > .0001). Recovery of LV function was 6.4-fold higher in women with baseline LVEF ≥ 30% (group III) and 3.9-fold higher in women with LVEF 20%-29% (group II) compared with those with LVEF 10%-19% (group I). Failure to achieve full recovery was seen in 63% of group I patients, 32% of group II (P = .03), and 21% of group III (P = .02 vs group I). Failure to achieve LVEF ≥30% was seen in 30% of group I patients and 13% of group II (P = .09).
  
  
  CONCLUSIONS
  Early recovery in patients with PPCM is significantly related to the degree of myocardial insult at time of diagnosis. Baseline LVEF however, has a limited sensitivity for prediction of failure to improve in individual patients and can not be used as an indication for premature use of aggressive therapy including devices or cardiac transplantation.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. sorelgoland@yahoo.com
authors.forename: Sorel
authors.initials: S
authors.lastname: Goland
authors.forename: Fahed
authors.initials: F
authors.lastname: Bitar
authors.forename: Kalgi
authors.initials: K
authors.lastname: Modi
authors.forename: Jordan
authors.initials: J
authors.lastname: Safirstein
authors.forename: Angela
authors.initials: A
authors.lastname: Ro
authors.forename: James
authors.initials: J
authors.lastname: Mirocha
authors.forename: Nudrat
authors.initials: N
authors.lastname: Khatri
authors.forename: Uri
authors.initials: U
authors.lastname: Elkayam
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058725:Peripartum Period / Q000502:physiology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D055815:Young Adult