Nugrahani Annisa Dewi, Maulana Sidik, Tjandraprawira Kevin Dominique, Santoso Dhanny Primantara Johari, Setiawan Dani, Pribadi Adhi, Siddiq Amillia, Pramatirta Akhmad Yogi, Aziz Muhammad Alamsyah, Irianti Setyorini
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Padjadjaran, Dr. Slamet General Hospital Garut, Bandung 45363, West Java, Indonesia.
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung 45363, West Java, Indonesia.
J Clin Med. 2023 Aug 15;12(16):5303. doi: 10.3390/jcm12165303.
Peripartum cardiomyopathy (PPCM) is a form of new-onset heart failure that has a high rate of maternal morbidity and mortality. This was the first study to systematically investigate and compare clinical factors and echocardiographic findings between women with PPCM and co-incident hypertensive pregnancy disorders (HPD-PPCM) and PPCM-only women. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) framework. We used four databases and a single search engine, namely PubMed/Medline, Scopus, Web of Science, and Cochrane. We used Cochrane Risk of Bias (RoB) 2.0 for quality assessment. Databases were searched for relevant articles published from 2013 to the end of April 2023. The meta-analysis used the DerSimonian-Laird random-effects model to analyze the pooled mean difference (MD) and its -value. We included four studies with a total of 64,649 participants and found that systolic blood pressure was significantly more likely to be associated with the PPCM group than the HPD-PPCM group (SMD = -1.63) (95% CI; -4.92,0.28, = 0.01), while the other clinical profiles were not significant. HPD-PPCM was less likely to be associated with LVEF reduction (SMD = -1.55, [CI: -2.89, -0.21], = 0.02). HPD-PPCM was significantly associated with less LV dilation (SMD = 1.81; 95% (CI 0.07-3.01), = 0.04). Moreover, HPD-PPCM was less likely to be associated with relative wall thickness reduction (SMD = 0.70; 95% CI (-1.08--0.33), = 0.0003). In conclusion, PPCM and HPD-PPCM shared different clinical profiles and remodeling types, which may affect each disease's response to pharmacological treatment. Patients with HPD-PPCM exhibited less eccentric remodeling and seemed to have a higher chance of recovering their LV ejection fraction, which means they might not benefit as much from ACEi/ARB and beta-blockers. The findings of this study will guide the development of guidelines for women with PPCM and HPD-PPCM from early detection to further management.
围产期心肌病（PPCM）是一种新发心力衰竭形式，孕产妇发病率和死亡率较高。这是第一项系统调查和比较PPCM合并高血压妊娠疾病（HPD-PPCM）的女性与单纯PPCM女性的临床因素和超声心动图结果的研究。我们遵循系统评价和荟萃分析的首选报告项目（PRISMA）框架。我们使用了四个数据库和一个搜索引擎，即PubMed/Medline、Scopus、Web of Science和Cochrane。我们使用Cochrane偏倚风险（RoB）2.0进行质量评估。在数据库中搜索2013年至2023年4月底发表的相关文章。荟萃分析使用DerSimonian-Laird随机效应模型分析合并平均差（MD）及其P值。我们纳入了四项研究，共64649名参与者，发现收缩压与PPCM组的相关性显著高于HPD-PPCM组（标准化均数差[SMD]=-1.63）（95%可信区间[-4.92,0.28]，P=0.01），而其他临床特征不显著。HPD-PPCM与左心室射血分数降低的相关性较小（SMD=-1.55，[可信区间：-2.89，-0.21]，P=0.02）。HPD-PPCM与左心室扩张程度较小显著相关（SMD=1.81；95%（可信区间0.07-3.01），P=0.04）。此外，HPD-PPCM与相对室壁厚度降低的相关性较小（SMD=0.70；95%可信区间（-1.08--0.33），P=0.0003）。总之，PPCM和HPD-PPCM具有不同的临床特征和重塑类型，这可能会影响每种疾病对药物治疗的反应。HPD-PPCM患者表现出较少的离心性重塑，似乎左心室射血分数恢复的机会更高，这意味着他们可能从血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和β受体阻滞剂中获益较少。本研究结果将指导制定从早期检测到进一步管理PPCM和HPD-PPCM女性的指南。
