Peripartum cardiomyopathy is defined as left ventricular dilation and failure, first
developing during the third trimester of pregnancy or in the first 6 months postpartum.
In an effort to characterize this syndrome in a middle class population, 14 consecutive
patients with peripartum cardiomyopathy underwent a detailed history and physical
examination, right heart catheterization, M-mode and two-dimensional echocardiography,
radionuclide ventriculography and right ventricular endomyocardial biopsy. These patients
were then observed with sequential noninvasive studies to determine prognostic indicators.
Eight (57%) of these 14 patients were primiparous and an equal number first presented
with heart failure concomitant with or immediately before the onset of labor. When
these women were compared with 55 patients with idiopathic dilated cardiomyopathy,
only mean age at onset of symptoms (28.7 +/- 5.7 versus 48.2 +/- 13.6 years, p less
than 0.001) and symptom duration (4.1 +/- 7.7 versus 19.0 +/- 18.4 months, p less
than 0.001) differed between the groups. There was no difference in ventricular arrhythmia,
left ventricular chamber size, ejection fraction or hemodynamics. Myocyte histologic
findings were similar; however, myocarditis was identified in 29% of patients with
peripartum cardiomyopathy and in only 9% of those with idiopathic dilated cardiomyopathy.
In all patients with peripartum cardiomyopathy and myocarditis, the myocardial biopsy
was performed within 1 week of onset of symptoms. Seven (50%) of the patients with
peripartum cardiomyopathy had dramatic improvement within 6 weeks of follow-up, and
6 (43%) died.(ABSTRACT TRUNCATED AT 250 WORDS)