Predictors of Mortality or Heart Transplantation in Peripartum Cardiomyopathy

Predictors of Mortality or Heart Transplantation in Peripartum Cardiomyopathy Background Peripartum cardiomyopathy is an uncommon form of congestive heart failure with an unpredictable outcome. Very little is known about its real incidence and prevalence, and its etiology is still unknown, although a number of contributing factors, including diverse risk factors, have been proposed. Objective To analyze the predictors of mortality or need for heart transplantation. Methods Between 1992 and November 2011, 23 patients were retrospectively evaluated. Patients with decompensated heart failure were managed with hemodynamic monitoring. Median follow-up was of 7.3 years (3.2-17.5). Univariate Cox regression analysis was performed and overall survival was calculated using the Kaplan-Meier method. Results Mean age was 28.7±8.8 years; eight patients were multipara. Seventy three percent were in functional class III-IV. Systolic blood pressure and diastolic blood pressure were 103±23 and 67±11 mm Hg, respectively, and heart rate was 92±19 bpm. All the patients were in sinus rhythm. The cardiothoracic index was 0.56±0.07. End-diastolic and end-systolic left ventricular dimensions were 67.5±10.2 and 56.7±10.1 mm, respectively; left atrial dimension was 42.5±6 mm and left ventricular ejection fraction was 24.6%±10.8%. Mean pulmonary artery pressure was 25±9 mm Hg and pulmonary wedge pressure, was 18.4±7.8 mm Hg; cardiac index was 2.6±0.6 L/min/m2. Seven patients died and three patients underwent heart transplantation. Univariate analysis revealed that functional class, cardiac index, systolic and diastolic blood pressure, pulmonary wedge pressure and mean pulmonary artery pressure, cardiothoracic index and left atrial dimension were associated with mortality and heart transplantation. Survival at one, three and six years was of 91%, 82% y 64%, respectively. Conclusions In-hospital mortality was of 4.3% and the need for heart transplantation or mortality during follow-up was of 39%. The hemodynamic parameters at admission were the main predictors of mortality and transplant.