Peripartum cardiomyopathy: Analysis of clinical outcome, left ventricular function, plasma levels of cytokines and Fas/APO-1

OBJECTIVES 1) To evaluate the outcome of patients with peripartum cardiomyo pathy (PPC) on current treatment for heart failure, 2) to assess the: circu lating plasma levels of cytokines and Fas receptors and 3) to identify pred ictors of prognosis. BACKGROUND Previous studies in patients with PPC were done when angiotensin -converting enzyme (ACE) inhibitors and beta-adrenergic blocking agents wer e not routinely used in heart failure. Inflammatory cytokines play an impor tant role in the pathogenesis and progression of heart failure of other eti ologies. However,:there is a paucity of data regarding cytokine expression in patients with PPC. Plasma:concentrations of Fas receptors tan apoptosis- signalling receptor) have not been reported-in this population. METHODS We followed prospectively 29 consecutive black women with PPC. All patients were treated with diuretics, digoxin, enalapril and carvedilol. Ec hocardiograms were performed at baseline and after six months of treatment. Cytokine and soluble Fas/APO-1 plasma levels were measured at baseline. RESULTS Tumor necrosis factor-alpha, interleukin-6 and Fas/APO-1 levels wer e significantly elevated in the study patients compared with 20 healthy vol unteers. Eight patients died. sFas/APO-1 levels were significantly higher i n patients who died compared with survivors (8.98 +/- 4.5 vs. 5.33 +/- 3 U/ ml, respectively, p = 0.02). Ar:six;months, ejection fraction improved from 26.7 +/- 10 to 42.7 +/- 16%, p = 0.00003, with-an increment of more than 1 0 U in 10 patients (28.1 +/- 4 to 51.9 +/- 8%, p = 0.000008). CONCLUSIONS Cytokine and sFas levels are elevated id patients with PPC. Des pite treatment with ACE inhibitors and beta-blockers, mortality :remains hi gh. However, in 34% of the patients, left ventricular function almost compl etely normalized. (C) 2000 by the American College of Cardiology.