Lu Cheng-Hui, Lee Wen-Chen, Wu Michael, Chen Shao-Wei, Yeh Jih-Kai, Cheng Chun-Wen, Wu Katie Pei-Hsuan, Wen Ming-Shien, Chen Tien-Hsing, Wu Victor Chien-Chia
Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan Division of Cardiology, Weill Cornell Medical Center, New York Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center Department of Infectious Diseases, Chang Gung Memorial Hospital, Linkou Medical Center Department of Rehabilitation, Chang Gung Memorial Hospital, Linkou Medical Center College of Medicine, Chang Gung University, Taoyuan City, Taiwan Department of Cardiology, Chang Gung Memorial Hospital, Keelung, Taiwan.
Medicine (Baltimore). 2017 May;96(19):e6898. doi: 10.1097/MD.0000000000006898.
Peripartum cardiomyopathy (PPCM), often classified as a form of dilated cardiomyopathy (DCM), is the myocardial dysfunction that occurs in late pregnancy and through the first few postpartum months.The aim of this study is to investigate the differences in the clinical outcomes of PPCM and DCM.Electronic medical records from 1997 to 2011 were retrieved from the Taiwan National Health Insurance Research Database. Patients with PPCM were compared with age- and clinical characteristics-matched patients with DCM. Primary outcomes were 1- and 3-year heart failure (HF) readmission, cardiac death, all-cause mortality, and major adverse cardiovascular events. Secondary outcomes were myocardial infarction, new onset of dialysis, heart transplant, and cerebrovascular accident. Follow-up period was divided into "within the first year" and "after the first year."A total of 527,979 patients (253,166 females) were hospitalized with a principal diagnosis of HF during 1997 to 2011 period. After excluding patients aged <18 and >50 years, patients with other forms of HF, and those with a history of cerebrovascular accidents or coronary artery disease, 797 patients with PPCM and 1267 patients with DCM were evaluated. Propensity score matching yielded 391 patients in each group. Patients with DCM had a significantly worse prognosis compared to those with PPCM for all primary and secondary outcomes at the 1- and 3-year follow-ups. After 1 year, the HF readmission rate did not significantly differ between the 2 diseases, suggesting that HF medications should be aggressively instituted in patients with PPCM.This is the first study to directly compare the clinical outcomes between age-matched patients with PPCM and DCM. Patients with PPCM had a significantly better prognosis across all cardiovascular endpoints compared to patients with DCM.
围产期心肌病（PPCM）通常被归类为扩张型心肌病（DCM）的一种形式，是发生在妊娠晚期及产后最初几个月的心肌功能障碍。本研究的目的是调查PPCM和DCM临床结局的差异。从台湾国民健康保险研究数据库中检索了1997年至2011年的电子病历。将PPCM患者与年龄及临床特征相匹配的DCM患者进行比较。主要结局为1年和3年心力衰竭（HF）再入院、心源性死亡、全因死亡率和主要不良心血管事件。次要结局为心肌梗死、新发透析、心脏移植和脑血管意外。随访期分为“第一年以内”和“第一年以后”。在1997年至2011年期间，共有527,979例患者（253,166名女性）因主要诊断为HF而住院。排除年龄<18岁和>50岁的患者、其他形式HF患者以及有脑血管意外或冠状动脉疾病病史的患者后，对797例PPCM患者和1267例DCM患者进行了评估。倾向评分匹配后每组有391例患者。在1年和3年随访时，DCM患者在所有主要和次要结局方面的预后均明显差于PPCM患者。1年后，两种疾病的HF再入院率无显著差异，这表明应对PPCM患者积极使用HF药物。这是第一项直接比较年龄匹配的PPCM和DCM患者临床结局的研究。与DCM患者相比，PPCM患者在所有心血管终点方面的预后均明显更好。
