PERIPARTUM CARDIOMYOPATHY - A LONGITUDINAL ECHOCARDIOGRAPHIC STUDY

OBJECTIVE: Our purpose was to determine echocardiographic trends after initial diagnosis of peripartum cardiomyopathy. STUDY DESIGN: Nine wo men diagnosed with peripartum cardiomyopathy were prospectively recrui ted for a longitudinal echocardiographic study. Severe myocardial dysf unction was defined as left ventricular end-diastolic dimension greate r than or equal to 60 mm + fractional shortening less than or equal to 21%: and mild dysfunction was defined as left ventricular end-diastol ic dimension <60 mm + fractional shortening 22% to 24%. Unpaired t tes ts were used to compare sample means and Fisher's exact test used to c ompare discrete variables. RESULTS: All women were seen initially for pulmonary edema. Echocardiography showed decreased systolic function i n all women. The mean age at diagnosis was 33.0 +/- 6.9 years. All but one woman had a diagnosis of either chronic hypertension (n = 6) or p reeclampsia (n = 2). Four women were first seen ante partum and five p ost parium (range 1 day to 2 months). Repeat echocardiography was perf ormed in all nine women (median 8 months, range 6 weeks to 5 years). T here was no correlation between antepartum or postpartum presentation and cardiovascular status on fellow-up (p = 0.3). values for initial l eft ventricular end-diastolic dimension, severe versus mild dysfunctio n (68.3 +/- 7.2 mm vs 55.0 +/- 4.2 mm, p = 0.046), follow-up left vent ricular end-diastolic dimension, severe versus mild (68.7 +/- 4.1 mm v s 52.0 +/- 5.7 mm, p = 0.002), and follow-up fractional shortening, se vere versus mild (14.6% +/- 5.0% vs 28.5% +/- 9.2%, p = 0.02) are sign ificant. Six of the seven women with severe dysfunction had stable dis ease in follow-up and one is awaiting heart transplant. One of the two women with mild dysfunction had disease resolution and one had stable disease. CONCLUSION: Patients with severe myocardial dysfunction due to peripartum cardiomyopathy are unlikely to regain normal cardiac fun ction on follow-up.