Predictors of left ventricular recovery in a cohort of peripartum cardiomyopathy patients recruited via the internet

Published:September 28, 2010DOI:https://doi.org/10.1016/j.ijcard.2010.08.065

      Abstract

      Background

      Peripartum cardiomyopathy (PPCM) is the onset of acute heart failure without demonstrable cause during the last month of pregnancy or within five months after delivery. The purpose of this study was to create a prospective registry of PPCM patients with the assistance of the internet and identify clinical factors predictive of ejection fraction (EF) recovery.

      Methods

      Patients with PPCM were identified by novel web-based methods. Subjects were categorized as recovered (EF>50) or nonrecovered (EF<50) and compared on the basis of demographic and clinical variables.

      Results

      Fifty-five subjects met criteria for inclusion. There was a statistically significant association between diagnosis during third trimester and persistent systolic dysfunction (25% vs. 4.7%, p=0.03). Gestational hypertension and breastfeeding were significantly associated with EF recovery (48.8% vs. 16.7%, p=0.046, and 39.5% vs. 8.3%, p=0.04, respectively). EF normalization occurred in all patients with EF135%.

      Conclusions

      Presence of gHTN, EF35% at diagnosis, breastfeeding, and postpartum diagnosis were all significantly associated with recovery of systolic function. Internet recruitment may be a valuable tool for studying PPCM.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to International Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gouley B.A.
        • McMillan T.M.
        • Bellet S.
        Idiopathic myocardial degeneration associated with pregnancy and especially the puerperium.
        Am J Med Sci. 1937; 19: 185-199
        • Demakis J.
        • Rahimtoola S.H.
        • Sutton G.C.
        • et al.
        Natural course of peripartum cardiomyopathy.
        Circulation. 1971; 44: 1053
        • Lampert M.B.
        • Lang R.M.
        Peripartum Cardiomyopathy.
        Am Heart J. 1995; 130: 860-870
        • Elkayam U.
        • Tummala P.P.
        • Rao K.
        • et al.
        Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy.
        N Engl J Med. 2001; 344: 1567-1571
        • Barr S.S.
        • Khan S.S.
        • Sandhu G.K.
        • et al.
        Incidence, mortality, and racial differences in peripartum cardiomyopathy.
        Am J Cardiol. 2007; 100: 302-304
        • Mackay A.P.
        • Berg C.J.
        • Atrash H.K.
        Pregnancy-related mortality from preeclampsia and eclampsia.
        Obstet Gynecol. 2001; 97: 533-538
        • Whitehead S.J.
        • Berg C.J.
        • Chang J.
        Pregnancy-related mortality due to cardiomyopathy: United States, 1991–97.
        Paediatr Perinat Epidemiol. 2008; 15: A36-A37
        • Sliwa K.
        • Damasceno A.
        • Mayosi B.M.
        Epidemiology and etiology of cardiomyopathy in Africa.
        Circulation. 2005; 112: 3577
        • Ventura S.J.
        • Peters K.D.
        • Martin J.A.
        • Maurer J.D.
        Births and deaths: United States, 1996.
        Mon Vital Stat Rep. 1997; 46: 1-40
        • Fett J.D.
        • Christie L.G.
        • Carraway R.D.
        • Murphy J.G.
        Five-year prospective study of the incidence and prognosis of peripartum cardiomyopathy at a single institution.
        Mayo Clin Proc. 2005; 80: 1602
      1. AmothersHeart.org. Available at: http://www.amothersheart.org.com.

      2. Google Incorporated, Mountain View, California, USA, authors. Google Groups.

      3. Survey Monkey. Available at: http://www.surveymonkey.com.

        • Elkayam U.
        • Akhter M.W.
        • Singh H.
        • et al.
        Pregnancy-associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation.
        Circulation. 2005; 111: 2050-2055
        • Manolio T.A.
        • Baughman K.L.
        • Rodeheffer R.
        • et al.
        Prevalence and etiology of idiopathic dilated cardiomyopathy (summary of a National Heart, Lung and Blood Institute workshop).
        Am J Cardiol. 1992; 69: 1458
        • Hibbard J.U.
        • Lindheimer M.
        • Lang R.M.
        A modified definition for peripartum cardiomyopathy and prognosis based on echocardiography.
        Obstet Gynecol. 1999; 94: 311-316
        • Pearson G.
        • Veille J.C.
        • Rahimtoola S.
        • et al.
        Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review.
        Jama. 2000; 283: 1183
        • Mechery J.
        Peripartum cardiomyopathy and pre-eclampsia: an infrequently associated obstetric emergency.
        J Obstet Gynaecol. 2005; 25: 606-607
        • Abboud J.
        • Murad Y.
        • Chen-Scarabelli C.
        • Saravolatz L.
        • Scarabelli T.M.
        Peripartum cardiomyopathy: a comprehensive review.
        Int J Cardiol. 2007; 118: 295-303
        • Ntusi N.B.
        • Mayosi B.M.
        Aetiology and risk factors of peripartum cardiomyopathy: a systematic review.
        Int J Cardiol. 2009; 131: 168-179
        • Hilfinker-Kleiner D.
        • Kaminski K.
        • Podewski E.
        • Bonda T.
        • Schaefer A.
        • Sliwa K.
        • et al.
        A cathespin D-cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy.
        Cell. 2007; 128: 589-600
        • Hilfiker-Kleiner D.
        • Sliwa K.
        • Drexler H.
        Peripartum cardiomyopathy: recent insights in its pathophysiology.
        Trends Cardiovasc Med. 2008; 18: 173-179
        • Jahns B.G.
        • Stein W.
        • Hilfiker-Kleiner D.
        • Pieske B.
        • Emons G.
        Peripartum cardiomyopathy – a new treatment option by inhibition of prolactin secretion.
        Am J Obstet Gynecol. 2008; 199: e5-e6
        • de Jong J.S.
        • Rietveld K.
        • van Lochem L.T.
        • Bouma B.J.
        Rapid left ventricular recovery after cabergoline treatment in a patient with peripartum cardiomyopathy.
        Eur J Heart Fail. 2009; 11: 220-222
        • Sliwa K.
        • Blauwet L.
        • Tibazarwa K.
        • Libhaber E.
        • Smedema J.P.
        • Becker A.
        • et al.
        Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proof-of-concept pilot study.
        Circulation. 2010; 121: 1465-1473
        • Fett J.D.
        Caution in the use of bromocriptine in peripartum cardiomyopathy.
        J Am Coll Cardiol. 2008; 51: 2083
        • Habedank D.
        • Kühnle Y.
        • Elgeti T.
        • Dudenhausen J.W.
        • Haverkamp W.
        • Dietz R.
        Recovery from peripartum cardiomyopathy after treatment with bromocriptine.
        Eur J Heart Fail. 2008; 10: 1149-1151
        • Lampert M.B.
        • Weinert L.
        • Hibbard J.
        • Korcarz C.
        • Lindheimer M.
        • Lang R.M.
        Contractile reserve in patients with peripartum cardiomyopathy and recovered left ventricular function.
        Am J Obstet Gynecol. 1997; 176: 189
        • Ravikishore A.
        • Kaul U.A.
        • Sethi K.K.
        • Khalilullah M.
        Peripartum cardiomyopathy: prognostic variables at initial evaluation.
        Int J Cardiol. 1991; 32: 377
        • Simeon I.A.
        Echocardiographic profile of peripartum cardiomyopathy in a tertiary care hospital in Sokoto, Nigeria.
        Indian Heart J. 2006; 58: 234-238
        • Amos A.M.
        • Jaber W.A.
        • Russell S.D.
        Improved outcomes in peripartum cardiomyopathy with contemporary.
        Am Heart J. 2006; 152: 509-513
        • Chapa J.B.
        • Heiberger H.B.
        • Weinert L.
        • Decara J.
        • Lang R.M.
        • Hibbard J.U.
        Prognostic value of echocardiography in peripartum cardiomyopathy.
        Obstet Gynecol. 2005; 105: 1303-1308
        • Witlin A.G.
        • Mabie W.C.
        • Sibai B.M.
        Peripartum cardiomyopathy: a longitudinal echocardiographic study.
        Am J Obstet Gynecol. 1997; 177: 1129-1132
        • Elkayam U.
        • Akhter M.W.
        • Singh H.
        • et al.
        Pregnancy-associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation.
        Circulation. 2005; 111: 2050-2055
        • Goland S.
        • Modi K.
        • Bitar F.
        • Janmohamed M.
        • Mirocha J.M.
        • Czer L.S.
        • et al.
        Clinical profile and predictors of complications in peripartum cardiomyopathy.
        J Card Fail. 2009; 15: 645-650
        • Modi K.
        • Illum S.
        • Jariatul K.
        • Caldito G.
        • Reddy P.C.
        Poor outcome of indigent patients with peripartum cardiomyopathy in the United States.
        Am J Obstet Gynecol. 2009; 201 (171e1-e5)
        • Coats A.J.
        Ethical authorship and publishing.
        Int J Cardiol. 2009; 131: 149-150