Department of Cardiology, Xiamen Key Laboratory of Cardiac Electrophysiology, Xiamen Institute of Cardiovascular Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361003, China.
Department of Echocardiography, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, China.
Heart Lung. 2023 Jul-Aug;60:81-86. doi: 10.1016/j.hrtlng.2023.02.021. Epub 2023 Mar 16.
Peripartum cardiomyopathy (PPCM) is a potentially life-threatening complication of pregnancy, but identifying patients at higher risk of this condition remains difficult.
We conducted a study to identify new risk factors associated with PPCM and predictors of poor outcomes.
This retrospective analysis included a total of 44 women with PPCM. As a control group, 79 women who gave birth around the same time as the PPCM patients and who did not have organic disease were included. A multivariate regression analysis was conducted to identify risk factors associated with PPCM and with delayed recovery.
All PPCM patients were discharged within 28 days. In comparison to the control group, PPCM patients had higher rates of preeclampsia (20.4% vs. 1.27%, P<0.001), autoimmune disease (27.3% vs. 11.4%, P = 0.018), and cesarean delivery with preterm labor (31.8% vs. 17.7%, P = 0.037). The neonates of PPCM patients had lower birth weight (2.70±0.66 kg vs. 3.21±0.57 kg, P<0.001). PPCM patients had higher levels of C-reactive protein, d-dimer, brain natriuretic peptide (BNP), and serum phosphorus, but lower levels of albumin and serum calcium (all P<0.001). In all patients with PPCM, the left ventricular ejection fraction (LVEF) returned to normal (≥50%) within 28 days after admission. Subjects with early recovery (n = 34) had lower BNP than those with delayed recovery (n = 10) (649.7 ± 526.0 pg/mL vs. 1444.1 ± 1040.8 pg/mL, P = 0.002). Multivariate regression led to a three-point score system to predict PPCM (1 point each for the presence of pericardial effusion, left ventricular dilatation, and d-dimer level ≥0.5 μg/mL). At a cutoff of ≥2, this scoring system predicted delayed recovery with 95.5% sensitivity and 96.1% specificity. The negative predictive value was 97.4% and the positive predictive value was 93.3%. Binary logistic regression indicated that PPCM patients with pulmonary hypertension, lower hemoglobin, or worse LVEF tended to require longer hospital stay (minimum 14 days).
A risk score that consists of pericardial effusion, left ventricular dilatation, and d-dimer level ≥ 0.5 μg/mL could help streamline the diagnosis of PPCM prior to confirmatory investigations. Moreover, a risk score that consists of pulmonary hypertension, lower hemoglobin and worse LVEF could help to predict poor outcomes in PPCM patients.
围产期心肌病（PPCM）是妊娠的一种潜在危及生命的并发症，但识别出处于这种疾病更高风险的患者仍然很困难。
我们进行了一项研究，以确定与 PPCM 相关的新危险因素和不良预后的预测因素。
这项回顾性分析共纳入了 44 名 PPCM 患者。作为对照组，纳入了 79 名在同一时期分娩且无器质性疾病的妇女。进行多变量回归分析以确定与 PPCM 相关的危险因素以及与延迟恢复相关的危险因素。
所有 PPCM 患者均在 28 天内出院。与对照组相比，PPCM 患者的子痫前期发生率更高（20.4% vs. 1.27%，P<0.001）、自身免疫性疾病发生率更高（27.3% vs. 11.4%，P=0.018）、剖宫产合并早产发生率更高（31.8% vs. 17.7%，P=0.037）。PPCM 患者的新生儿出生体重较低（2.70±0.66kg vs. 3.21±0.57kg，P<0.001）。PPCM 患者的 C 反应蛋白、D-二聚体、脑钠肽（BNP）和血清磷水平较高，而白蛋白和血清钙水平较低（均 P<0.001）。所有 PPCM 患者的左心室射血分数（LVEF）在入院后 28 天内均恢复正常（≥50%）。早期恢复的患者（n=34）的 BNP 低于延迟恢复的患者（n=10）（649.7±526.0pg/mL vs. 1444.1±1040.8pg/mL，P=0.002）。多变量回归得出了一个三点评分系统来预测 PPCM（各有 1 分，分别为心包积液、左心室扩张和 D-二聚体水平≥0.5μg/mL）。当截断值≥2 时，该评分系统以 95.5%的灵敏度和 96.1%的特异性预测延迟恢复。阴性预测值为 97.4%，阳性预测值为 93.3%。二项逻辑回归表明，患有肺动脉高压、血红蛋白较低或 LVEF 较差的 PPCM 患者往往需要更长的住院时间（至少 14 天）。
一种由心包积液、左心室扩张和 D-二聚体水平≥0.5μg/mL 组成的评分系统有助于在进行确认性检查之前简化 PPCM 的诊断。此外，一种由肺动脉高压、较低的血红蛋白和更差的 LVEF 组成的评分系统可以帮助预测 PPCM 患者的不良预后。
