Clinical Characteristics and Long-term Predictors of Persistent Left Ventricular Systolic Dysfunction in Peripartum Cardiomyopathy

Abstract

Background: Peripartum cardiomyopathy (PPCM) is a potentially life-threatening dilated cardiomyopathy that occurs in previously well women during pregnancy or postpartum. The predictors of persistent left ventricular (LV) systolic dysfunction (LVSD) in PPCM are poorly understood and were the subject of this study.

Methods: Patients with PPCM (n = 71), who were admitted to Beijing Friendship Hospital from 2004 to 2011, were retrospectively analyzed. Data including electrocardiographic and echocardiographic measurements at diagnosis (baseline) and at the last follow-up visit were collected. Data on plasma brain natriuretic peptide (BNP) and C-reactive protein (CRP) levels were also collected at baseline. A receiver operating characteristic curve was used to determine the cutoff values. Univariate and multivariate analyses were used to assess the significant predictive variables for persistent LVSD.

Results: Thirty-one patients (44%) did not recover completely at the last follow-up visit (LV nonrecovery group), and 40 patients (56%) had good LV recovery (LV recovery group). Baseline BNP level was positively correlated with LV end-diastolic diameter (r = 0.559; P < 0.001), and inversely correlated with LV ejection fraction (LVEF) (r = -0.548; P < 0.001) and fractional shortening (r = -0.542; P < 0.001). There was no difference in CRP levels between the 2 groups. Receiver operating characteristic curves indicated the cutoff value in terms of predicting persistent LVSD was 34% for LVEF, 64 mm for LV end-diastolic diameter, 16% for fractional shortening, and 1860 pg/mL for BNP. Univariate and multivariate analyses confirmed that LVEF < 34% (95% CI, 1.38-7.30; P = 0.007) and BNP > 1860 pg/mL (95% CI, 1.18-6.99; P = 0.020) were independent prognostic factors in predicting persistent LVSD.

Conclusions: LVEF and plasma BNP levels have good predictive value in long-term cardiac dysfunction.