Profile of peripartum cardiomyopathy cases and outcome on maternal cardiac status with six month follow up

Abstract

Background: Peripartum cardiomyopathy (PPCM) is a rare type of cardiomyopathy of unknown aetiology associated with significant mortality and morbidity and characterized by heart failure in late pregnancy or puerperium. Diagnosis remains a challenge, as PPCM symptoms vary and may mimic those commonly experienced by women during pregnancy and postpartum. Objectives: to evaluate profile of peripartum cardiomyopathy in pregnant women and analyze their outcome on maternal cardiac status with six month follow up. Methods: In this retrospectively designed study all patients admitted with the diagnosis of acute severe PPCM at three service hospitals in the country located in central India, North-eastern and western region, meeting the inclusion criteria over a period of 7 years, were enrolled and followed up for 6 months post partum. The LVEF and Left ventricular end diastolic dimension (LVEDD) was assessed by echocardiography at baseline, 3 months and six month postpartum. Mortality and survival with normal or depressed ejection fraction were determined. Predictors of outcome were evaluated. Results: The presentation of the cases of in our setup was different and outcome was much better than most of the reported series. In our cases, in majority acute deterioration in unregistered cases in NYHA Class IV in multi-gravida was noted. In follow up for 6 months, there was only one mortality noted unrelated to cardiomyopathy. Conclusion: We conclude that our subset of PPCM cases had different risk factors such multiparity, advance age, poor socioeconomic status, hypertension and to colitis use as risk factors. New drugs were used prior to the pregnancy, such as pentoxyphyline, bromocriptine and cabergoline along with digoxin, diuretics and continuation of beta-blockers. Newer interventions such as plasmapheresis, immunoadsorption, ventricular assist devices and heart transplantation were not used. One mortality case was noted in 6 month follow up.

Keywords:Beta-Blockers, Congestive Heart Failure (CHF), Heart Failure, Peripartum Cardiomyopathy.