Predictors of Mortality or Heart Transplantation in Peripartum Cardiomyopathy

pp.41-48

Abstract

Background
Peripartum cardiomyopathy is an uncommon form of congestive heart failure with unpredictable outcome. Very little is known about its real incidence and prevalence, and its etiology is still unknown, although a number of contributing factors, including diverse risk factors, have been proposed.

Objective
The aim of this study was to analyze the predictors of mortality or need for heart transplantation.

Methods
Twenty three patients were retrospectively evaluated between 1992 and November 2011. Patients with decompensated heart failure were managed with hemodynamic monitoring. Median follow-up was 7.3 years (3.2-17.5). Univariate Cox regression analysis was performed and overall survival was calculated using the Kaplan-Meier method.

Results
Mean age was 28.7±8.8 years and 8 patients were multipara. Seventy three percent of patients were in functional class III-IV. Systolic blood pressure and diastolic blood pressure were 103±23 and 67±11 mm Hg, respectively, and heart rate was 92±19bpm. All patients were in sinus rhythm. The cardiothoracic index was 0.56±0.07. End diastolic and end-systolic left ventricular dimensions were 67.5±10.2 and 56.7±10.1mm, respectively; left atrial dimension was 42.5±6 mm and left ventricular ejection fraction was 24.6%±10.8%. Mean pulmonary artery pressure was 25±9 mm Hg and pulmonary capillary wedge pressure 18.4±7.8 mm Hg; cardiac index was 2.6±0.6L/min/m2. Seven patients died and 3 patients underwent heart transplantation. Univariate analysis revealed that functional class, cardiac index, systolic and diastolic blood pressure, pulmonary capillary wedge pressure, mean pulmonary artery pressure, cardiothoracic index and left atrial dimension were associated with mortality and heart transplantation. Survival at one, three and six years was 91%, 82% y 64%, respectively.

Conclusions
In-hospital mortality was 4.3% and need for heart transplantation or mortality during follow-up was 39%. Hemodynamic parameters at admission were the main predictors of mortality and heart transplantion.