Biteker Murat, Özlek Bülent, Özlek Eda, Çil Cem, Çelik Oğuzhan, Doğan Volkan, Başaran Özcan
Department of Cardiology, Muğla Sıtkı Koçman University, Faculty of Medicine, Muğla, Turkey.
J Matern Fetal Neonatal Med. 2020 Feb;33(3):390-397. doi: 10.1080/14767058.2018.1494146. Epub 2018 Sep 27.
Predictors of early or delayed recovery are unclear in peripartum cardiomyopathy (PPCM). Therefore, we aimed to assess the prognostic value of serial assessment of clinical, echocardiographic, and biochemical markers in patients with PPCM. Fifty-two consecutive women with PPCM were enrolled in this prospective study. Each patient underwent transthoracic echocardiography, B-type natriuretic peptide (BNP) and C-reactive protein (CRP) measurement at admission, and every 3 months. Early recovery was defined as resolution of heart failure at 6 months postdiagnosis, delayed recovery was defined if the length of time required for recovery of left ventricular function was longer than 6 months, and persistent left ventricular dysfunction (PLVD) was defined as an ejection fraction of less than 50% at the end of follow-up. Thirty patients (57.7%) recovered completely, 10 died (19.2%), and 12 (23.1%) had PLVD. There were no significant differences in baseline BNP and CRP values between patients who recovered completely and who did not recover. However, patients with complete recovery were more likely to have a higher left ventricular ejection fraction, smaller left ventricle end-systolic dimensions at baseline, and lower CRP and BNP levels at follow-up. Elevated levels of BNP and CRP on follow up at 3 and 6 months were associated with nonrecovery. Third and sixth month BNP values were significantly lower in patients with rapid recovery, compared to patients with delayed recovery. Bromocriptine therapy was also associated with early recovery. Persistent elevation of plasma CRP and BNP levels at follow-up portend a slower response or nonrecovery in patients with PPCM. Bromocriptine therapy was an independent predictor of early recovery.
围产期心肌病（PPCM）早期或延迟恢复的预测因素尚不清楚。因此，我们旨在评估对PPCM患者进行临床、超声心动图和生化指标系列评估的预后价值。52例连续的PPCM女性患者纳入了这项前瞻性研究。每位患者在入院时以及之后每3个月接受一次经胸超声心动图检查、测量B型利钠肽（BNP）和C反应蛋白（CRP）。早期恢复定义为诊断后6个月心力衰竭症状消失；如果左心室功能恢复所需时间超过6个月，则定义为延迟恢复；持续性左心室功能障碍（PLVD）定义为随访结束时射血分数低于50%。30例患者（57.7%）完全康复，10例死亡（19.2%），12例（23.1%）出现PLVD。完全康复和未康复患者的基线BNP和CRP值无显著差异。然而，完全康复的患者更有可能具有较高的左心室射血分数、基线时较小的左心室收缩末期内径以及随访时较低的CRP和BNP水平。随访3个月和6个月时BNP和CRP水平升高与未康复相关。与延迟恢复的患者相比，快速恢复的患者在第三个月和第六个月时的BNP值显著更低。溴隐亭治疗也与早期恢复相关。随访时血浆CRP和BNP水平持续升高预示着PPCM患者反应较慢或无法康复。溴隐亭治疗是早期恢复的独立预测因素。
