Kim Dong-Yeon, Kim So Ree, Park Sung-Ji, Seo Jeong-Hun, Kim Eun Kyoung, Yang Jeong Hoon, Chang Sung-A, Choi Jin-Oh, Lee Sang-Chol, Park Seung Woo
Division of Cardiology, Department of Internal Medicine, Seoul Paik Hospital, Inje University, Seoul, Korea.
Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
ESC Heart Fail. 2020 Dec;7(6):3644-3652. doi: 10.1002/ehf2.12889. Epub 2020 Sep 8.
Although some peripartum-associated cardiomyopathy patients present with features that are clinically and echocardiographically similar to those of takotsubo cardiomyopathy (TCM), little is known about the diagnosis and clinical course of peripartum TCM.
In a tertiary hospital in Seoul, Korea, we searched the hospital database to find cardiomyopathy cases that were associated with pregnancy from January 1995 to May 2019. Applying the published diagnostic criteria, we sought peripartum cardiomyopathy (PPCM) and peripartum TCM patients for comparison. Of 31 pregnancy-associated cardiomyopathy patients, 10 cases of peripartum TCM and 21 cases of PPCM were found. Maternal near-miss death was significantly more common in the peripartum TCM group than in the PPCM group (100.0% vs. 57.1%, P = 0.030). Complete recovery was observed with all peripartum TCM cases, while 23.8% of the PPCM cases had residual left ventricular dysfunction. One death and one heart transplantation occurred in the PPCM group, while neither occurred in the peripartum TCM group. There was no difference between the two groups in terms of the rate of major adverse clinical events at 3 years of follow-up [PPCM group: 26.3% (5/19) vs. TCM group: 33.3% (3/9), P = 0.750].
One-third of pregnancy-associated cardiomyopathy patients had peripartum TCM. With contemporary supportive care, both PPCM and peripartum TCM patients had a low mortality rate and excellent long-term outcomes.
虽然一些围产期心肌病患者在临床和超声心动图上表现出与应激性心肌病（TCM）相似的特征，但围产期应激性心肌病的诊断和临床过程却鲜为人知。
在韩国首尔的一家三级医院，我们检索了医院数据库，以查找1995年1月至2019年5月期间与妊娠相关的心肌病病例。应用已发表的诊断标准，我们寻找围产期心肌病（PPCM）和围产期应激性心肌病患者进行比较。在31例与妊娠相关的心肌病患者中，发现10例围产期应激性心肌病和21例围产期心肌病。围产期应激性心肌病组孕产妇险些死亡的情况明显比围产期心肌病组更常见（100.0%对57.1%，P = 0.030）。所有围产期应激性心肌病病例均观察到完全恢复，而23.8%的围产期心肌病病例有左心室功能不全残留。围产期心肌病组发生1例死亡和1例心脏移植，而围产期应激性心肌病组均未发生。在3年随访时，两组主要不良临床事件发生率无差异[围产期心肌病组：26.3%（5/19）对应激性心肌病组：33.3%（3/9），P = 0.750]。
三分之一的与妊娠相关的心肌病患者患有围产期应激性心肌病。通过当代的支持性治疗，围产期心肌病和围产期应激性心肌病患者的死亡率均较低，且长期预后良好。
