title: Predictors of outcome in 176 South African patients with peripartum cardiomyopathy.
abstract: OBJECTIVE
  Identify novel prognostic factors for patients with peripartum cardiomyopathy (PPCM).
  
  
  METHODS
  Prospective cohort study conducted in a single tertiary care centre in South Africa.
  
  
  METHODS
  176 African women with newly diagnosed PPCM were studied.
  
  
  METHODS
  Clinical assessment, echocardiography and laboratory results were obtained at baseline and at 6 months.
  
  
  METHODS
  Poor outcome was defined as the combined end point of death, left ventricular (LV) ejection fraction (LVEF) < 35%, or remaining in New York Heart Association (NYHA) functional class III/IV at 6 months. Complete LV recovery was defined as LVEF ≥55% at 6 months.
  
  
  RESULTS
  Forty-five (26%) patients had a poor outcome. Multiple logistic regression analysis revealed that, after adjustment for age, NYHA functional class, LVEF and systolic blood pressure, increased left ventricular end systolic dimension (LVESD), lower body mass index (BMI) and lower total cholesterol at baseline were independent predictors of poor outcome (adjusted OR 1.09, 95% CI 1.04 to 1.15, p=0.001; OR 0.89, 95% CI 0.83 to 0.96, p=0.004, and OR 0.50, 95% CI 0.34 to 0.73, p=0.0004, respectively). Thirty (21%) of the 141 surviving patients with echocardiographic follow-up recovered LV function at 6 months. Multiple logistic regression analysis revealed that, after adjustment for NYHA functional class, LVEF and left ventricular end diastolic dimension, older age and smaller LVESD at baseline were predictors of LV recovery (OR 1.08, 95% CI 1.01 to 1.17, p=0.02 and OR 0.92, 95% CI 0.86 to 0.98, p=0.007, respectively).
  
  
  CONCLUSIONS
  This study suggests that increased LVESD, lower BMI and lower serum cholesterol at baseline may be independent predictors of poor outcome in patients with PPCM, while older age and smaller LVESD at baseline appear to be independently associated with a higher chance of LV recovery.
authors.affiliation: Department of Medicine, Division of CardiovascularDiseases, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Blauwet
authors.forename: Elena
authors.initials: E
authors.lastname: Libhaber
authors.forename: Olaf
authors.initials: O
authors.lastname: Forster
authors.forename: Kemi
authors.initials: K
authors.lastname: Tibazarwa
authors.forename: Alex
authors.initials: A
authors.lastname: Mebazaa
authors.forename: Denise
authors.initials: D
authors.lastname: Hilfiker-Kleiner
authors.forename: Karen
authors.initials: K
authors.lastname: Sliwa
mesh_terms: D000293:Adolescent; D000328:Adult; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009017:Morbidity / Q000639:trends; D058725:Peripartum Period; D011379:Prognosis; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology; D016277:Ventricular Function, Left / Q000502:physiology*; D055815:Young Adult