A modified definition for peripartum cardiomyopathy and prognosis based onechocardiography

The diagnosis of peripartum cardiomyopathy is one of exclusion, made after careful search for an underlying cause. Research in this area is compromise d by the reliance of some on clinical criteria alone without strict echocar diographic criteria. This article argues for uniform criteria that define p eripartum cardiomyopathy, similar to the criteria for idiopathic dilated ca rdiomyopathy set forth by a National Heart, Lung, and Blood Institute-spons ored workshop and proposes that the new definition include heart failure wi thin the last month of pregnancy or 5 months postpartum; absence of preexis ting heart disease; no determinable etiology, the traditional definition; a nd strict echocardiographic criteria of left ventricular dysfunction: eject ion fraction less than 45%, or M-mode fractional shortening less than 30%, or both, and end-diastolic dimension more than 2.7 cm/m(2). Mortality from peripartum cardiomyopathy remains high, 25-50%, and a recent review related long-term prognosis to echocardiographic measures of left ventricular cham ber dimension and function at diagnosis and recovery. We describe a modifie d pharmacologic echocardiographic stress test that might be useful in deter mining left ventricular contractile reserve in women believed to be recover ed by routine echocardiographic studies. The test reproduces hemodynamic st ress akin to pregnancy, and the data might be useful when counseling women on future childbearing. Women who respond with reduced cardiac reserve migh t be advised to avoid pregnancy. (C) 1999 by The American College of Obstet ricians and Gynecologists.