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      Peripartum cardiomyopathy: ten year experience at a tertiary care hospital in Pakistan

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          Abstract

          Background

          There is very little literature regarding peripartum cardiomyopathy from the Asian countries. We conducted this study to determine demographic details, clinical presentations, complications and recovery of left ventricular (LV) systolic function in peripartum cardiomyopathy (PPCMP) patients of Pakistani origin.

          Method

          A ten year retrospective case series of PPCMP was conducted at the Aga Khan University Hospital. Patients were also followed up for six months after presentation, with special regard to improvement in the LV function.

          Results

          Total 45 patients were included, 25 (55.5%) primigravida and 8 (17.7%) gravida 2 and the remaining 12 (26.6%) were multigravida. Fourteen patients (31.1%) presented during pregnancy and 31 (68.8%) after delivery. All patients presented with CHF and three (6.6%) were complicated with ventricular tachycardia (VT) at presentation. LV systolic dysfunction was present in 39 (86.66%) patients and RV dysfunction in 15 (33.3%) patients. Two patients had LV clot and thromboembolic stroke occurred in another 4 patients. All patients received standard treatment except three patients who had asthma and could not be given beta blockers. Echocardiogram was repeated after 6 month and in 32 (71.1%) patients LV functions recovered to normal. RV function improved in all except 2 (4.4%) patients. All patients were discharged in stable condition.

          Conclusion

          Significant numbers of PPCMP patients, who had severe LV dysfunction at presentation recovered their LV functions at six month follow up.

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          Pregnancy-associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation.

          Fadi F. Bitar, Uri Elkayam, W Akhter … (2005)
          Cardiomyopathy associated with pregnancy was first described more than half a century ago. However, because of its rare occurrence and geographical differences, the clinical profile of this condition has remained incompletely defined. Data obtained from 123 women with a history of cardiomyopathy diagnosed during pregnancy or the postpartum period were reviewed. One hundred women met traditional criteria of peripartum cardiomyopathy; 23 were diagnosed with pregnancy-associated cardiomyopathy earlier than the last gestational month. Peripartum cardiomyopathy patients had a mean age of 31+/-6 years and were mostly white (67%). Common associated conditions were gestational hypertension (43%), tocolytic therapy (19%), and twin pregnancy (13%). Left ventricular ejection fraction at the time of diagnosis was 29+/-11% and improved to 46+/-14% (P 30% at diagnosis. Maternal mortality was 9%. A comparison between the peripartum cardiomyopathy and early pregnancy-associated cardiomyopathy groups revealed no differences in age, race, associated conditions, left ventricular ejection fraction at diagnosis, its rate and time of recovery, and maternal outcome. This study helps to define the clinical profile of patients with pregnancy-associated cardiomyopathy diagnosed in the United States. Clinical presentation and outcome of patients with pregnancy-associated cardiomyopathy diagnosed early in pregnancy are similar to those of patients with traditional peripartum cardiomyopathy. These 2 conditions may represent a continuum of a spectrum of the same disease.
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            Peripartum cardiomyopathy.

            Uri Elkayam, Karen Sliwa, James D. Fett (2006)
            Peripartum cardiomyopathy (PPCM) is a disorder in which initial left ventricular systolic dysfunction and symptoms of heart failure occur between the late stages of pregnancy and the early postpartum period. It is common in some countries and rare in others. The causes and pathogenesis are poorly understood. Molecular markers of an inflammatory process are found in most patients. Clinical presentation includes usual signs and symptoms of heart failure, and unusual presentations relating to thromboembolism. Clinicians should consider PPCM in any peripartum patient with unexplained disease. Conventional heart failure treatment includes use of diuretics, beta blockers, and angiotensin-converting enzyme inhibitors. Effective treatment reduces mortality rates and increases the number of women who fully recover left ventricular systolic function. Outcomes for subsequent pregnancy after PPCM are better in women who have first fully recovered heart function. Areas for future research include immune system dysfunction, the role of viruses, non-conventional treatments such as immunosuppression, immunoadsorption, apheresis, antiviral treatment, suppression of proinflammatory cytokines, and strategies for control and prevention.
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              Improved outcomes in peripartum cardiomyopathy with contemporary.

              Wael A Jaber, Sally Amos, Stuart D. Russell (2006)
              Prior studies have shown both high morbidity and mortality for patients with peripartum cardiomyopathy (PPCM). These studies were small and predated current advances in heart failure treatment. We sought to determine the outcomes of women with PPCM in the contemporary era and to determine predictors of poor outcome. Patients with PPCM from 1990 to 2003 were identified retrospectively through screening of heart failure clinics and echocardiography records. Their records were reviewed, and current clinical status was determined. Fifty-five patients were identified with an average follow-up of 43 months. Their mean initial ejection fraction (EF) was 20%. Compared with their initial EF, 62% of patients improved, 25% were unchanged, and 4% declined. No patients died, and 10% eventually required transplant. At 2 months after diagnosis, 75% of those who eventually recovered had an EF >45%. Factors associated with lack of recovery at initial assessment were a left ventricular (LV) end-diastolic dimension >5.6 cm, the presence of LV thrombus, and African-American race. Recovery of LV function was not predicted by the initial EF. Among patients who recovered, the withdrawal of heart failure medications was not associated with decompensation over a follow-up of 29 months. The morbidity related to PPCM is less than previously reported. Initial LV end-diastolic dimension and EF at 2 months predict long-term outcomes. The discontinuation of heart failure medications after recovery did not lead to decompensation.
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                Author and article information

                Contributors
                Abid Hussain Laghari
                Aamir Hameed Khan
                Khawar Abbas Kazmi
                Journal
                Journal ID (nlm-ta): BMC Res Notes
                Journal ID (iso-abbrev): BMC Res Notes
                Title: BMC Research Notes
                Publisher: BioMed Central
                ISSN (Electronic): 1756-0500
                Publication date Collection: 2013
                Publication date (Electronic): 1 December 2013
                Volume: 6
                Page: 495
                Affiliations
                [1 ]Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
                Article
                Publisher ID: 1756-0500-6-495
                DOI: 10.1186/1756-0500-6-495
                PMC ID: 4222096
                PubMed ID: 24289218
                SO-VID: 7aa354c2-21c8-4cf6-9908-650a96f91a89
                Copyright © Copyright © 2013 Laghari et al.; licensee BioMed Central Ltd.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 2 July 2013
                Date accepted : 23 November 2013
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Medicine
                Keywords: peripartum cardiomyopathy,left ventricular systolic dysfunction,right ventricular dysfunction
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: peripartum cardiomyopathy, left ventricular systolic dysfunction, right ventricular dysfunction

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