RESULTS:
Thirty-seven patients that met the ESC PPCM criteria were included in
the study. The mean age was 30.5±5.6 years. All patients first presented
with HF symptoms; six patients also had left ventricular thrombus, and
two had a concomitant acute pulmonary embolism.
Six patients (16.2%) had a diagnosis of hypertension, four patients had
preeclampsia before the diagnosis of HF, seven (18.9%) patients had
diabetes mellitus, and three (8.1%) patients had a smoking history
before pregnancy. Four (10.8%) patients reported a family history of HF
related to non-ischemic CM. Two (8.3%) patients’ rhythm was atrial
fibrillation, two patients had left bundle branch block (LBBB), one
patient presented with right bundle branch block (RBBB) at baseline, and
eight (21.6%) patients had implanted ICD.
Of the PPCM patients, 28 (80%) were treated with ACE-i or ARB, 33
(94.2%) patients with beta-blocker, and 25 (75.3%) patients were on
mineralocorticoid receptor antagonists during the follow-up period.
Three patients who presented acute HF were treated with bromocriptine
(Table 1).
The mean baseline LVEF was 28.2±6.7%, the mean left ventricular
end-diastolic diameter (LVEDd) was 59.6±7.4 mm, and the left ventricular
end-systolic diameter (LVESd) was 50.1±8.5 mm. Twenty-two (62.9%)
patients had moderate or severe functional mitral regurgitation, and 15
(42.9%) patients had moderate or severe functional tricuspid
regurgitation. On the last follow-up, 24 patients’ echocardiography was
re-assessed, and the mean LVEF was 39.9±13.5%. During the follow-up
period, the mean LVEF change was 11.7±15.7% (p=0.001) (Table 2).
In thirteen (35.7%) patients, left ventricular systolic function
recovered during the follow-up course. The median recovery time was
281(IQR [78-358]) days.
Cox regression analysis did not demonstrate a significant predictor for
recovery.