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Peripartum Cardiomyopathy Study - 2005

June, 2005 - We reviewed medical records to study whether echo
results at time of PPCM diagnosis predict chronic heart
failure down the road.
	We reviewed patient charts from 1988 to 2001. Echos
were done when PPCM was first diagnosed in these women.
Fractional shortening (FS) was used instead of EF. Fractional
shortening less than 30% and left ventricular size when filled
with blood of 4.8 cm or more was called PPCM.
	Of 32 such PPCM patients, 13 (41%) recovered normal
heart function within 3 months. Nineteen patients (59%) did
not, and had chronic CHF after diagnosis.
	At diagnosis, women who did not recover normal heart
function had more enlarged hearts and lower FS (EF) than those
who recovered. FS less than 20% and left ventricle end
diastolic size of 6 cm or more at diagnosis indicated 300%
higher risk for chronic CHF.
	The researchers say echocardiograms seem very valuable in
diagnosing PPCM, and also to help predict outcome.

This tidbit is about pregnancy after PPCM, from the study data:

All 4 women with recovered heart function who later became
pregnant got CHF again during their third trimester. Oddly,
the 2 women with chronic CHF after PPCM diagnosis that later
got pregnant, did not get any worse during or after their later
pregnany.

Title:   Prognostic value of echocardiography in peripartum
         cardiomyopathy.
Authors: Chapa JB, Heiberger HB, Weinert L, Decara J, Lang RM,
         Hibbard JU.
Source:  Obstet Gynecol. 2005 Jun;105(6):1303-8.
From:    Departments of Obstetrics and Gynecology and Internal
         Medicine, University of Chicago, Pritzker School of
         Medicine, Chicago, Illinois, USA - jeff.chapa@uhhs.com
PMID:    15932821.

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PPCM

Peripartum cardiomyopathy causes an important percentage of
pregnancy-related deaths. Patients should be diagnosed by
physical exam and echocardiogram. Standard heart failure meds
should be used after giving birth. Heart biospy in these
patients is rarely useful.
	Significant improvement in heart function can be
expected in up to 50% of PPCM patients.

Title:   Peripartum Cardiomyopathy: Current Therapeutic
         Perspectives.
Authors: Phillips SD, Warnes CA.
Source:  Curr Treat Options Cardiovasc Med. 2004 Dec;6(6):481-488.
PMID:    15496265.

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Later Pregnancy in PPCM Patients

Later pregnancy in 6 patients with previous PPCM caused EF to
fall by more than 10% in 5 patients at one month after giving
birth.
	Two women with reduced EF at the beginning of the later
pregnancy died from heart failure 3 months after giving birth
despite best medical therapy. Left heart function worsened in
these women while TNF (Tumor Necrosis Factor-alpha) level rose
from 2.4 at beginning of pregnancy to 6.2 one month after giving
birth.

Title:   Outcome of subsequent pregnancy in patients with documented
         peripartum cardiomyopathy.
Authors: Sliwa K, Forster O, Zhanje F, Candy G, Kachope J, Essop R.
From:    Department of Cardiology, Chris Hani Baragwanath Hospital,
         University of the Witwatersrand, Johannesburg, South Africa.
         hahnle@netactive.co.za
Source:  Am J Cardiol. 2004 Jun 1;93(11):1441-3, A10.

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