Brar Somjot S, Khan Steven S, Sandhu Gagandeep K, Jorgensen Michael B, Parikh Neil, Hsu Jin-Wen Y, Shen Albert Yuh-Jer
Kaiser Permanente, Los Angeles, California, USA.
Am J Cardiol. 2007 Jul 15;100(2):302-4. doi: 10.1016/j.amjcard.2007.02.092. Epub 2007 Jun 6.
There are no large population-based studies on the incidence and prognosis of peripartum cardiomyopathy (PC). Between 1996 and 2005, there were 241,497 deliveries within the Southern California Kaiser healthcare system. Among these, we identified 60 cases of PC by searching for an International Classification of Diseases, Ninth Edition diagnosis of heart failure (HF) and detailed chart review. PC was confirmed if all of the following criteria were satisfied: (1) left ventricular ejection fraction <0.50, (2) met the Framingham criteria for HF, (3) new symptoms of HF or initial echocardiographic diagnosis of left ventricular dysfunction occurred in the month before or in the 5 months after delivery, and (4) no alternative cause of HF could be identified. The overall incidence of PC was 1 in 4,025 deliveries. The incidence in whites, African-Americans, Hispanics, and Asians was 1 of 4,075, 1 of 1,421, 1 of 9,861, and 1 of 2,675 deliveries, respectively. The incidence of PC was greatest in African-Americans, which was 2.9-fold higher compared with whites (p = 0.03) and 7-fold that of Hispanics (p <0.001). With a mean follow-up of 4.7 years, the freedom from all-cause death was 96.7% by the Kaplan-Meier method. In conclusion, this large population-based study highlights important racial differences in the incidence of PC. We observed the lowest incidence of PC in Hispanics and the highest in African-Americans. Our findings also suggest that the current mortality associated with PC may be less than reported in older series, perhaps because of the high utilization of modern HF therapy.
目前尚无基于大规模人群的围产期心肌病（PC）发病率及预后研究。1996年至2005年期间，南加州凯撒医疗系统内共有241,497例分娩。在此期间，我们通过查找国际疾病分类第九版心力衰竭（HF）诊断编码并详细查阅病历，确定了60例PC病例。若满足以下所有标准，则确诊为PC：（1）左心室射血分数<0.50；（2）符合弗雷明汉HF标准；（3）在分娩前1个月或分娩后5个月内出现HF新症状或首次超声心动图诊断为左心室功能障碍；（4）无法确定HF的其他病因。PC的总体发病率为每4,025例分娩中有1例。白人、非裔美国人、西班牙裔和亚裔的发病率分别为每4,075例、1,421例、9,861例和2,675例分娩中有1例。PC发病率在非裔美国人中最高，与白人相比高出2.9倍（p = 0.03），是西班牙裔的7倍（p <0.001）。平均随访4.7年，采用Kaplan-Meier法得出全因死亡自由生存率为96.7%。总之，这项基于大规模人群的研究突出了PC发病率存在的重要种族差异。我们观察到西班牙裔中PC发病率最低，非裔美国人中最高。我们的研究结果还表明，目前与PC相关的死亡率可能低于既往报道，这可能是由于现代HF治疗的高利用率。
