Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
Columbia University Vagelos College of Physicians & Surgeons, New York, NY.
J Am Heart Assoc. 2018 Apr 23;7(9):e008378. doi: 10.1161/JAHA.117.008378.
Outcomes in peripartum cardiomyopathy (PPCM) vary. We sought to determine whether severity of left or right ventricular dysfunction (RVD) at PPCM diagnosis differentially associates with adverse outcomes.
We conducted a single-center retrospective cohort study of 53 patients with PPCM. The primary outcome was a composite of left ventricular assist device implantation, cardiac transplantation, or death. We used Kaplan-Meier curves to examine event-free survival and Cox proportional hazards models to examine associations of left ventricular (LV) ejection fraction <30%, LV end-diastolic diameter ≥60 mm, and moderate-to-severe RVD at PPCM diagnosis with the primary outcome. Median (interquartile range) follow-up time was 3.6 (1.4-7.3) years. Seventeen patients (32%) experienced the primary outcome, of whom 11 had moderate-to-severe RVD at time of PPCM diagnosis. Overall event-free survival differed by initial RVD severity and LV ejection fraction <30%, but not by LV end-diastolic diameter ≥60 mm. In univariable analyses, LV ejection fraction <30% and moderate-to-severe RVD were associated with the outcome (hazard ratios [95% confidence intervals] of 4.85 [1.11-21.3] and 4.26 [1.47-11.6], respectively). In a multivariable model with LV ejection fraction <30%, LV end-diastolic diameter ≥60 mm, and moderate-to-severe RVD, only moderate-to-severe RVD was independently associated with the outcome (hazard ratio [95% confidence interval], 3.21 [1.13-9.10]). Although most outcomes occurred within the first year, nearly a third occurred years after PPCM diagnosis.
Initial moderate-to-severe RVD is associated with a more advanced cardiomyopathy phenotype and increased risk of adverse outcomes in PPCM, within and beyond the first year of diagnosis. By identifying a worse PPCM phenotype, initial moderate-to-severe RVD may prompt earlier consideration of advanced heart replacement therapies.
围生期心肌病（PPCM）的结局存在差异。我们旨在确定 PPCM 诊断时左心室或右心室功能障碍（RVD）的严重程度是否与不良结局存在差异。
我们对 53 例 PPCM 患者进行了单中心回顾性队列研究。主要结局是左心室辅助装置植入、心脏移植或死亡的复合终点。我们使用 Kaplan-Meier 曲线来检查无事件生存率，使用 Cox 比例风险模型来检查 PPCM 诊断时左心室射血分数（LVEF）＜30%、左心室舒张末期直径（LVEDD）≥60mm 和中重度 RVD 与主要结局的相关性。中位（四分位间距）随访时间为 3.6（1.4-7.3）年。17 例（32%）患者发生主要结局，其中 11 例在 PPCM 诊断时存在中重度 RVD。整体无事件生存率因初始 RVD 严重程度和 LVEF＜30%而异，但与 LVEDD≥60mm 无关。单变量分析中，LVEF＜30%和中重度 RVD 与结局相关（风险比[95%置信区间]分别为 4.85[1.11-21.3]和 4.26[1.47-11.6]）。在包含 LVEF＜30%、LVEDD≥60mm 和中重度 RVD 的多变量模型中，仅中重度 RVD 与结局独立相关（风险比[95%置信区间]，3.21[1.13-9.10]）。尽管大多数结局发生在诊断后的 1 年内，但仍有近三分之一发生在 PPCM 诊断后数年。
初始中重度 RVD 与更严重的 PPCM 心肌病表型相关，并增加了诊断后 1 年内及之后不良结局的风险。通过识别更严重的 PPCM 表型，初始中重度 RVD 可能促使更早考虑更先进的心脏替代治疗。
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