Scientific Council of Cardiology, Iraqi Board for Medical Specializations, Baghdad, Iraq.
Baghdad Heart Center, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq.
ESC Heart Fail. 2021 Oct;8(5):4048-4054. doi: 10.1002/ehf2.13502. Epub 2021 Jun 28.
This study aimed to evaluate the clinical characteristics, echocardiographic measurements, medical treatment, pregnancy outcomes, and the 6 month follow-up outcomes among patients with peripartum cardiomyopathy (PPCM) in Iraq.
Data were collected prospectively at cardio-maternal clinic in Baghdad Heart Center, using case report form for the EORP-PPCM registry from January 2015 to November 2020. Six month follow-up was performed either by attendance of patients or by phone contact. A total of 64 PPCM patients were enrolled with a mean age of 32.1 ± 6.8 years. Diagnosis in 35 (54.7%) women was made in the post-partum period. There was a history of previous PPCM in 9 (14%), coexisting hypertension with the current pregnancy in 30 (51.7%), cholelithiasis in 5 (7.8%), and cancer in 3 (4.7%). Baseline mean left ventricular ejection fraction (LVEF) was 34.7 ± 8.1%, significantly higher than that reported globally (31 ± 10%) (P-value 0.011), and 26 (40.6%) of our patients had LVEF of ≤34%. Baseline mean global longitudinal strain (GLS) for 26 (40.6%) patients was -9.4 ± 4.1%. Baseline mean left ventricular end-diastolic and end-systolic dimensions were 61.2 ± 8.5 and 50.6 ± 10.2 mm, respectively. At 6 month follow-up, 11 (36.7%) women recovered their LVEF, lower than global data (46%) but higher than that in the Middle East (25%) with P-value 0.241 and 0.919, respectively. The mean LVEF was 44.5 ± 11.9%, and the mean GLS for 15 (23.4%) of patients was -13.4 ± 5.3%, including 5 (33.3%) with the range of -18.6% to -17%. Bromocriptine was the least used drug in 4 (8.2%) vs. globally reported (15%) (P-value 0.188). Thrombo-embolic events and maternal death were reported in 2 (4.1%) and 3 (4.7%) cases, respectively, within 6 months.
Around half of our PPCM patients were diagnosed at post-partum period with impaired initial LVEF and GLS, and one-third had early LVEF recovery at 6 month follow-up, higher than that in the Middle East but lower than the globally reported figure in the EORP-PPCM registry. Limited use of bromocriptine might explain the later finding. The co-morbid diseases in our setting were hypertension and cholelithiasis. Interestingly, the comparable ratios of neonatal and maternal mortalities in our study to that of the EORP-PPCM registry were found less than the Middle East figures. Bromocriptine needs to be considered in Middle East countries, including Iraq, which may be the key to improving LVEF recovery and perhaps reducing maternal mortality.
本研究旨在评估伊拉克围产期心肌病（PPCM）患者的临床特征、超声心动图测量值、药物治疗、妊娠结局和 6 个月随访结果。
数据是在巴格达心脏中心的心母诊所通过 EORP-PPCM 登记处的病例报告表，从 2015 年 1 月至 2020 年 11 月前瞻性收集的。通过患者就诊或电话联系进行 6 个月随访。共纳入 64 例 PPCM 患者，平均年龄 32.1±6.8 岁。35 例（54.7%）女性在产后期间被诊断为 PPCM。9 例（14%）以前有 PPCM 病史，30 例（51.7%）当前妊娠合并高血压，5 例（7.8%）有胆石症，3 例（4.7%）有癌症。基线左心室射血分数（LVEF）平均为 34.7±8.1%，明显高于全球报告的（31±10%）（P 值 0.011），我们的 26 例（40.6%）患者的 LVEF 为≤34%。26 例（40.6%）患者的基线平均整体纵向应变（GLS）为-9.4±4.1%。基线左心室舒张末期和收缩末期内径分别为 61.2±8.5mm 和 50.6±10.2mm。在 6 个月随访时，11 例（36.7%）女性的 LVEF 恢复，低于全球数据（46%），但高于中东地区（25%），P 值分别为 0.241 和 0.919。平均 LVEF 为 44.5±11.9%，15 例（23.4%）患者的平均 GLS 为-13.4±5.3%，其中 5 例（33.3%）的范围为-18.6%至-17%。与全球报告的（15%）相比，溴隐亭在 4 例（8.2%）患者中是使用最少的药物（P 值 0.188）。6 个月内报告了 2 例（4.1%）血栓栓塞事件和 3 例（4.7%）产妇死亡。
我们的 PPCM 患者中有一半左右在产后期间被诊断出 LVEF 和 GLS 受损，三分之一在 6 个月随访时出现早期 LVEF 恢复，高于中东地区，但低于 EORP-PPCM 登记处全球报告的数值。溴隐亭的使用受限可能解释了这一后期发现。我们的研究中合并的疾病是高血压和胆石症。有趣的是，我们的研究与 EORP-PPCM 登记处的中东地区相比，新生儿和产妇死亡率的比值较低。溴隐亭需要在包括伊拉克在内的中东国家考虑，这可能是提高 LVEF 恢复率并降低产妇死亡率的关键。
