Peripartum cardiomyopathy: Frequency and predictors and indicators of clinical outcome

To determine frequency and prognostic factors of peripartum cardiomyopathy.

The prospective cohort study was conducted from April 2012 to September 2013 at Civil Hospital, Karachi. Cases were collected in the first year, and were then followed up for six months. On clinical and transthoracic 2-D M Mode echocardiography, cases of prepartum peripartum cardiomyopathy were detected. After necessary lab tests, cardiac opinion and treatment, pregnancy was terminated using caesarean section. At complete clinical recovery, the subjects were discharged to be followed up in cardiac and gynaecology clinics with current echocardiograph at 3rd and 6th month. SPSS 15 was used for data analysis.

Out of 5742 deliveries, 22(0.38%) were cases of prepartum peripartum cardiomyopathy; the frequency being 3.8/1000 births. At 6-month follow-up, 14 (63.63%) cases recovered and 6(27.3%) did not. Two (9%) cases expired on 2nd and 16th day of delivery. On baseline or diagnostic echo, left ventricular ejection fraction and fractional shortening were statistically significant predictors of clinical outcome (p<0.05 each). Ejection fraction and fractional shortening were strong predictors of clinical outcome (p<0.05 each).During follow-up, left ventricular ejection fraction, fractional shortening, left ventricular internal dimension at diastole, and left ventricular internal dimension at systole (LVISd) were statistically significant indicators of clinical outcome (p<0.05 each).

Baseline and follow-up echo was the best tool for prognosis. Baseline left ventricular ejection fraction and fractional shortening were significant predictors of clinical outcome.