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Predictors of outcome in 176 South African patients with peripartum cardiomyopathy
  1. Lori A Blauwet1,
  2. Elena Libhaber2,3,
  3. Olaf Forster4,
  4. Kemi Tibazarwa2,5,
  5. Alex Mebazaa6,
  6. Denise Hilfiker-Kleiner7,
  7. Karen Sliwa2
  1. 1Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Hatter Institute for Cardiovascular Research in Africa, Cape Town, South Africa
  3. 3School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  4. 4MDH Health Centre, Ramada, Kenya
  5. 5Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
  6. 6Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France
  7. 7Molecular Cardiology, Department of Cardiology and Angiology, Medical School Hannover, Hannover, Germany
  1. Correspondence to Professor Karen Sliwa, Department of Medicine, Hatter Cardiovascular Research Institute, Medical School, Groote Schuur Hospital and University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa; sliwa-hahnlek{at}mdh-africa.org

Abstract

Objective Identify novel prognostic factors for patients with peripartum cardiomyopathy (PPCM).

Design and setting Prospective cohort study conducted in a single tertiary care centre in South Africa.

Patients 176 African women with newly diagnosed PPCM were studied.

Interventions Clinical assessment, echocardiography and laboratory results were obtained at baseline and at 6 months.

Main outcome measures Poor outcome was defined as the combined end point of death, left ventricular (LV) ejection fraction (LVEF) < 35%, or remaining in New York Heart Association (NYHA) functional class III/IV at 6 months. Complete LV recovery was defined as LVEF ≥55% at 6 months.

Results Forty-five (26%) patients had a poor outcome. Multiple logistic regression analysis revealed that, after adjustment for age, NYHA functional class, LVEF and systolic blood pressure, increased left ventricular end systolic dimension (LVESD), lower body mass index (BMI) and lower total cholesterol at baseline were independent predictors of poor outcome (adjusted OR 1.09, 95% CI 1.04 to 1.15, p=0.001; OR 0.89, 95% CI 0.83 to 0.96, p=0.004, and OR 0.50, 95% CI 0.34 to 0.73, p=0.0004, respectively). Thirty (21%) of the 141 surviving patients with echocardiographic follow-up recovered LV function at 6 months. Multiple logistic regression analysis revealed that, after adjustment for NYHA functional class, LVEF and left ventricular end diastolic dimension, older age and smaller LVESD at baseline were predictors of LV recovery (OR 1.08, 95% CI 1.01 to 1.17, p=0.02 and OR 0.92, 95% CI 0.86 to 0.98, p=0.007, respectively).

Conclusions This study suggests that increased LVESD, lower BMI and lower serum cholesterol at baseline may be independent predictors of poor outcome in patients with PPCM, while older age and smaller LVESD at baseline appear to be independently associated with a higher chance of LV recovery.

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