title: Peripartum cardiomyopathy: predictors of recovery and current state of implantable cardioverter-defibrillator use.
abstract: OBJECTIVE
  The purpose of this study was to identify the predictors of left ventricular (LV) recovery in patients with peripartum cardiomyopathy (PPCM) and to record rates of implantable cardioverter-defibrillator (ICD) use.
  
  
  BACKGROUND
  PPCM is a rare, life-threatening disease. The use of ICDs has not been clearly understood in this patient group. Identification of the predictors of persistent LV dysfunction can help select patients at risk for sudden cardiac death.
  
  
  METHODS
  A retrospective study was conducted at 2 academic centers between January 1, 1999, and December 31, 2012. Clinical and demographic variables and delivery records of patients with a diagnosis of PPCM (International Classification of Diseases, 9th Revision code 674.5) were reviewed. Improvement in LV function was noted from echocardiography reports.
  
  
  RESULTS
  The total sample comprised 100 patients, of whom 55% were African Americans, 39% were Caucasians, and 6% were Hispanic, with a mean age of 30 ± 6 years. Mean left ventricular ejection fraction (LVEF) at diagnosis was 28 ± 9%. Forty-two percent of patients showed improvement in LVEF over a mean duration of 33 ± 21 months. Postpartum diagnosis (hazard ratio: 3.0; p = 0.01) and Caucasian/Hispanic race (hazard ratio: 2.2; p = 0.01) were predictors of improvement in LVEF. Only 7 of the 58 patients (12%) who did not have improvement in their LVEF had an ICD implanted. There were 11 deaths, with a trend toward higher mortality in those who did not display improved LV function (15% vs. 5%; p = 0.1).
  
  
  CONCLUSIONS
  More than one-third of women with PPCM improve LV function with delayed recovery noted in the majority of these patients. Caucasians and those diagnosed in the postpartum period appear to be the most likely to recover. The rate of ICD implantation for primary prevention of sudden cardiac death in this patient group is low.
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital and Medical Center, Kansas City, Kansas.
authors.forename: Jayasree
authors.initials: J
authors.lastname: Pillarisetti
authors.affiliation: Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Ashok
authors.initials: A
authors.lastname: Kondur
authors.affiliation: Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Anas
authors.initials: A
authors.lastname: Alani
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital and Medical Center, Kansas City, Kansas.
authors.forename: Madhu
authors.initials: M
authors.lastname: Reddy
authors.affiliation: Department of Obstetrics & Gynecology, University of Kansas Hospital and Medical Center, Kansas City, Kansas.
authors.forename: Madhuri
authors.initials: M
authors.lastname: Reddy
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital and Medical Center, Kansas City, Kansas.
authors.forename: James
authors.initials: J
authors.lastname: Vacek
authors.affiliation: Department of Obstetrics & Gynecology, University of Kansas Hospital and Medical Center, Kansas City, Kansas.
authors.forename: Carl P
authors.initials: CP
authors.lastname: Weiner
authors.affiliation: Department of Epidemiology, University of Kansas Hospital and Medical Center, Kansas City, Kansas.
authors.forename: Edward
authors.initials: E
authors.lastname: Ellerbeck
authors.affiliation: Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Theodore
authors.initials: T
authors.lastname: Schreiber
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital and Medical Center, Kansas City, Kansas. Electronic address: dlakkireddy@kumc.edu.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000150:complications / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058725:Peripartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011322:Primary Prevention; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: cardiomyopathy; implantable cardioverter-defibrillator; peripartum