Peripartum cardiomyopathy: A longitudinal echocardiographic study, ,

Objective: Our purpose was to determine echocardiographic trends after initial diagnosis of peripartum cardiomyopathy. Study Design: Nine women diagnosed with peripartum cardiomyopathy were prospectively recruited for a longitudinal echocardiographic study. Severe myocardial dysfunction was defined as left ventricular end-diastolic dimension ≥60 mm + fractional shortening ≤21%, and mild dysfunction was defined as left ventricular end-diastolic dimension <60 mm + fractional shortening 22% to 24%. Unpaired t tests were used to compare sample means and Fisherʹs exact test used to compare discrete variables. Results: All women were seen initially for pulmonary edema. Echocardiography showed decreased systolic function in all women. The mean age at diagnosis was 33.0 ± 6.9 years. All but one woman had a diagnosis of either chronic hypertension (n = 6) or preeclampsia (n = 2). Four women were first seen ante partum and five post partum (range 1 day to 2 months). Repeat echocardiography was performed in all nine women (median 8 months, range 6 weeks to 5 years). There was no correlation between antepartum or postpartum presentation and cardiovascular status on follow-up (p = 0.3). Values for initial left ventricular end-diastolic dimension, severe versus mild dysfunction (68.3 ± 7.2 mm vs 55.0 ± 4.2 mm, p = 0.046), follow-up left ventricular end-diastolic dimension, severe versus mild (68.7 ± 4.1 mm vs 52.0 ± 5.7 mm, p = 0.002), and follow-up fractional shortening, severe versus mild (14.6% ± 5.0% vs 28.5% ± 9.2%, p = 0.02) are significant. Six of the seven women with severe dysfunction had stable disease in follow-up and one is awaiting heart transplant. One of the two women with mild dysfunction had disease resolution and one had stable disease. Conclusion: Patients with severe myocardial dysfunction due to peripartum cardiomyopathy are unlikely to regain normal cardiac function on follow-up.