title: Low systolic blood pressure and high resting heart rate as predictors of outcome in patients with peripartum cardiomyopathy.
abstract: BACKGROUND
  Patients with peripartum cardiomyopathy (PPCM) present with low blood pressure (SBP) often preventing uptitration of heart failure medication. We aimed to study prediction of risk and the contribution of high resting heart rate (HR) and low SBP to risk in recent onset of PPCM.
  
  
  METHODS
  Clinical assessment with HR and SBP, echocardiography and laboratory results were obtained at baseline and at six months on 206 patients with recent onset PPCM enrolled at two tertiary care centers in South Africa. Poor outcome was defined as the combined endpoint of death, LVEF<35% or remaining in New York Heart Association (NYHA) functional class III/IV at six months. Complete LV recovery was defined as LVEF ≥ 55% at six months.
  
  
  RESULTS
  Poor outcome was observed in 110 of 220 patients (53%), with 26 patients dying at six months (12.6%). There were 98 (47.5%) patients with SBP ≤ 110 mmHg. Patients with high HR (HR ≥ 100) and low SBP (< 110 mmHg) tended to have worse outcomes than patients below the HR median and high SBP. PPCM patients with low SBP and high HR were less likely to be on ACE-inhibitors (n = 35, 69% versus n = 129, 84%, p = 0.024) and on the beta blocker carvedilol (n = 24, 47% versus n = 98, 64%, p = 0.047). Low SBP, high HR and left ventricular end diastolic diameter at baseline were predictors of poor outcome. Patients with low SBP and high HR had the highest mortality (p = 0.0023).
  
  
  CONCLUSIONS
  These findings suggest increased risk in patients with PPCM presenting with low SBP and high HR on standard heart failure medication possibly having implications on HF management.
authors.affiliation: Soweto Cardiovascular Research Unit, University of the Witwatersrand, South Africa.
authors.forename: Elena
authors.initials: E
authors.lastname: Libhaber
authors.affiliation: Soweto Cardiovascular Research Unit, University of the Witwatersrand, South Africa.
authors.forename: Karen
authors.initials: K
authors.lastname: Sliwa
authors.affiliation: Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Kirrberger Str. 1, D 66424 Homburg, Saar, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Bachelier
authors.affiliation: Soweto Cardiovascular Research Unit, University of the Witwatersrand, South Africa.
authors.forename: Kim
authors.initials: K
authors.lastname: Lamont
authors.affiliation: Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Kirrberger Str. 1, D 66424 Homburg, Saar, Germany. Electronic address: michael.boehm@uks.eu.
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D058725:Peripartum Period / Q000502:physiology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging* / Q000401:mortality*; D013019:South Africa / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
keywords: Cardiomyopathy; Heart rate; PPCM; Pregnancy