Peripartum Cardiomyopathy Research Project, Department of Adult Medicine, Hôpital Albert Schweitzer, Deschapelles, Haiti.
Int J Gynaecol Obstet. 2010 Apr;109(1):34-6. doi: 10.1016/j.ijgo.2009.10.011. Epub 2009 Nov 30.
To quantify the level of risk for heart failure relapse in a subsequent pregnancy in women who have had peripartum cardiomyopathy (PPCM), and to test the hypothesis that meeting additional criteria may help lower the risk.
Prospectively-identified PPCM patients volunteering between 2003 and 2009 were identified from the PPCM Registry of Hôpital Albert Schweitzer, Deschapelles, Haiti, and an internet support group. Data were assessed for full adherence to monitoring and diagnostic criteria, clinical data, statistical analysis, and reporting.
Of 61 post-PPCM pregnancies identified, there were 18 relapses (29.5%) of heart failure. Of 26 pregnancies with a left ventricular ejection fraction (LVEF) of less than 0.55 prior to the pregnancy, relapse occurred in 12 (46.2%) pregnancies. Of 35 pregnancies with an LVEF of 0.55 or greater prior to the pregnancy, relapse occurred in 6 (17.1%) (P<0.01). No relapses occurred in 9 women who also demonstrated adequate contractile reserve.
The most important criterion associated with reduced risk for heart failure relapse in a post-PPCM pregnancy is recovery defined by an LVEF 0.55 or greater before the subsequent pregnancy. Exercise stress echocardiography showing adequate contractile reserve may help to identify women at an even lower risk of relapse.
量化患有围产期心肌病 (PPCM) 的女性在后续妊娠中心力衰竭复发的风险水平，并检验满足其他标准可能有助于降低风险的假设。
前瞻性地从海地德沙佩勒的阿尔伯特·施韦策医院的 PPCM 登记处和互联网支持小组中确定了 2003 年至 2009 年期间自愿参加的 PPCM 患者。评估了数据是否符合监测和诊断标准、临床数据、统计分析和报告的全部要求。
在 61 例 PPCM 后妊娠中，有 18 例（29.5%）心力衰竭复发。在妊娠前左心室射血分数（LVEF）小于 0.55 的 26 例妊娠中，有 12 例（46.2%）妊娠复发。在妊娠前 LVEF 为 0.55 或更高的 35 例妊娠中，有 6 例（17.1%）复发（P<0.01）。在 9 名显示出足够收缩储备的女性中，没有发生复发。
与 PPCM 后妊娠中心力衰竭复发风险降低相关的最重要标准是在随后的妊娠前 LVEF 达到 0.55 或更高，表明已经恢复。显示出足够收缩储备的运动应激超声心动图可能有助于识别复发风险更低的女性。
