The Heart Institute, Kaplan Medical Center, Rehovot, Israel.
Hadassah Medical School, Hebrew University, Jerusalem, Israel.
ESC Heart Fail. 2022 Dec;9(6):4262-4270. doi: 10.1002/ehf2.14141. Epub 2022 Sep 20.
To describe the effect of subsequent pregnancies (SSP) on left ventricular (LV) function and outcomes in patients with peripartum cardiomyopathy (PPCM).
Among146 women with PPCM who were prospectively followed at two medical centres in Israel (2007-2019), 75 SSPs (in 50 women) were identified: 8 miscarriages, 8 terminations, and 59 life birth.
Forty-five patients with 59 full-term SSPs [mean age was 32.9 ± 4.1 years, LV ejection fraction (LVEF) 57.7 ± 5.1%] were analysed. Data on LVEF at 1-month post-delivery were available in 46 and at 6 months in 36 SSPs. There was a small decrease in the mean LVEF, mostly at third trimester (57.2 ± 5.6 vs. 54.4. ± 7.3, P < 0.001); and at 1-mont (57.9 ± 5.7% vs. 55.4 ± 6.1%, P = 0.001) and at 6-month post-delivery (57.4 ± 6.1 vs. 55.3 ± 7.9%, P = 0.03). In patients with pre-SSP LV LVEF ≥55%, a mild reduction in the mean group LVEF was seen at 1-month post-delivery (P = 0.009). One patient with pre-SSP LVEF ≥55% developed severe relapse. In patients with pre-SSP LVEF <55%, a mild reduction in LVEF was obtained mostly at third trimester (51.1 ± 5.6 vs 47.0 ± 7.4%, P < 0.001), which persisted at 6 months (P = 0.03). A relapse was observed in three (25%) women with LVEF <55%. There was no maternal mortality, 32 patients delivered by caesarean section, and there were no foetal complications.
Our study indicates a favourable outcome and low likelihood of maternal mortality associated with SSP in women with a history of PPCM and recovered LV systolic function. SSP was associated with a slight reduction in LVEF mostly during the third trimester, which persisted up to 6 months after delivery.
描述围产期心肌病（PPCM）患者再次妊娠（SSP）对左心室（LV）功能和结局的影响。
在以色列的两个医疗中心对 146 名 PPCM 患者进行前瞻性随访（2007-2019 年），确定了 75 例 SSP（50 名患者）：8 例流产，8 例终止妊娠，59 例活产。
对 45 名患者的 59 例足月 SSP（平均年龄 32.9±4.1 岁，左心室射血分数[LVEF]为 57.7±5.1%）进行了分析。46 例患者产后 1 个月时 LVEF 数据可用，36 例患者产后 6 个月时 LVEF 数据可用。LVEF 在第三个月（57.2±5.6 对 54.4.±7.3，P<0.001）和产后 1 个月（57.9±5.7%对 55.4±6.1%，P=0.001）和产后 6 个月（57.4±6.1%对 55.3±7.9%，P=0.03）时均有轻微下降。在有 SSP 前 LVEF≥55%的患者中，在产后 1 个月时观察到平均 LVEF 有轻度下降（P=0.009）。1 例 SSP 前 LVEF≥55%的患者发生严重复发。在 SSP 前 LVEF<55%的患者中，LVEF 在第三个月（51.1±5.6 对 47.0±7.4%，P<0.001）和 6 个月时（P=0.03）均有轻度下降。3 名（25%）LVEF<55%的患者出现复发。无孕产妇死亡，32 名患者行剖宫产，无胎儿并发症。
本研究表明，在 PPCM 病史和恢复左心室收缩功能的女性中，再次妊娠（SSP）的结局良好，发生母亲死亡的可能性较低。SSP 与 LVEF 略有下降有关，主要发生在第三个月，产后 6 个月仍持续存在。
