Department of Medicine and Cardiology, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa.
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Eur Heart J. 2020 Oct 14;41(39):3787-3797. doi: 10.1093/eurheartj/ehaa455.
We sought to describe the clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy (PPCM) globally.
In 2011, >100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global registry on PPCM, under the auspices of the ESC EURObservational Research Programme. These societies were tasked with identifying centres who could participate in this registry. In low-income countries, e.g. Mozambique or Burkina Faso, where there are no national societies due to a shortage of cardiologists, we identified potential participants through abstracts and publications and encouraged participation into the study. Seven hundred and thirty-nine women were enrolled in 49 countries in Europe (33%), Africa (29%), Asia-Pacific (15%), and the Middle East (22%). Mean age was 31 ± 6 years, mean left ventricular ejection fraction (LVEF) was 31 ± 10%, and 10% had a previous pregnancy complicated by PPCM. Symptom-onset occurred most often within 1 month of delivery (44%). At diagnosis, 67% of patients had severe (NYHA III/IV) symptoms and 67% had a LVEF ≤35%. Fifteen percent received bromocriptine with significant regional variation (Europe 15%, Africa 26%, Asia-Pacific 8%, the Middle East 4%, P < 0.001). Follow-up was available for 598 (81%) women. Six-month mortality was 6% overall, lowest in Europe (4%), and highest in the Middle East (10%). Most deaths were due to heart failure (42%) or sudden (30%). Re-admission for any reason occurred in 10% (with just over half of these for heart failure) and thromboembolic events in 7%. Myocardial recovery (LVEF > 50%) occurred only in 46%, most commonly in Asia-Pacific (62%), and least commonly in the Middle East (25%). Neonatal death occurred in 5% with marked regional variation (Europe 2%, the Middle East 9%).
Peripartum cardiomyopathy is a global disease, but clinical presentation and outcomes vary by region. Just under half of women experience myocardial recovery. Peripartum cardiomyopathy is a disease with substantial maternal and neonatal morbidity and mortality.
我们旨在描述全球围产期心肌病（PPCM）患者的临床表现、治疗方法和 6 个月的转归。
2011 年，欧洲心脏病学会（ESC）的 100 多个国家和附属会员心脏学会被联系，在 ESC 欧洲观察性研究计划的主持下，参与 PPCM 的全球注册。这些协会的任务是确定能够参与该注册的中心。在低收入国家，例如莫桑比克或布基纳法索，由于心脏病专家短缺，没有国家协会，我们通过摘要和出版物确定了潜在的参与者，并鼓励他们参与研究。在欧洲（33%）、非洲（29%）、亚太地区（15%）和中东（22%）的 49 个国家共招募了 739 名妇女。平均年龄为 31±6 岁，平均左心室射血分数（LVEF）为 31±10%，10%的人曾有过一次妊娠并发 PPCM。症状发作最常见于分娩后 1 个月内（44%）。在诊断时，67%的患者有严重（纽约心脏协会 III/IV 级）症状，67%的患者 LVEF≤35%。15%的患者接受了溴隐亭治疗，且存在明显的区域差异（欧洲 15%，非洲 26%，亚太地区 8%，中东 4%，P<0.001）。598 名（81%）妇女可获得随访。总的 6 个月死亡率为 6%，欧洲最低（4%），中东最高（10%）。大多数死亡是由于心力衰竭（42%）或猝死（30%）。因任何原因再次入院的比例为 10%（其中一半以上是由于心力衰竭），血栓栓塞事件为 7%。只有 46%的患者出现心肌恢复（LVEF>50%），最常见于亚太地区（62%），而中东地区最少（25%）。新生儿死亡占 5%，且存在明显的区域差异（欧洲 2%，中东 9%）。
围产期心肌病是一种全球性疾病，但临床表现和结局因地区而异。近一半的女性出现心肌恢复。围产期心肌病是一种具有较大母体和新生儿发病率和死亡率的疾病。
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