Peripartum Cardiomyopathy
Peripartum Cardiomyopathy
复制标题
DOI：
10.1016/j.jacc.2014.04.014
复制
发表时间：
2014-07-01
影响因子：
24
通讯作者：
Lakkireddy, Dhanunjaya
中科院分区：
文献类型：
--
作者：
Pillarisetti, Jayasree;Kondur, Ashok;Lakkireddy, Dhanunjaya
目的本研究的目的是确定围生期心肌病（PPCM）患者左室（LV）恢复的预测因素，并记录植入式心律转复除颤器（ICD）的使用率。PPCM是一种罕见的危及生命的疾病。在这个患者群体中，icd的使用还没有得到明确的了解。确定持续性左室功能障碍的预测因素有助于选择有心源性猝死风险的患者。方法1999年1月1日至2012年12月31日，在2个学术中心进行回顾性研究。对诊断为PPCM（国际疾病分类，第9次修订代码674.5）患者的临床和人口统计学变量及分娩记录进行了回顾。超声心动图报告显示左室功能改善。结果共100例患者，其中55%为非裔美国人，39%为白种人，6%为西班牙裔，平均年龄30±6岁。诊断时平均左室射血分数（LVEF）为28 +/- 9%。42%的患者在33 +/- 21个月的平均持续时间内显示出LVEF的改善。产后诊断（危险比：3.0;p 0.01）和高加索/西班牙裔（危险比：2.2;p 0.01）是LVEF改善的预测因素。58例LVEF没有改善的患者中只有7例（12%）植入了ICD。11例死亡，左室功能未改善的患者死亡率呈上升趋势（15% vs. 5%; p 0.1）。结论：超过三分之一的PPCM患者的左室功能得到改善，其中大多数患者恢复延迟。白种人和产后确诊的人似乎最有可能康复。该患者组植入率较低，用于一级预防心源性猝死。(C) 2014年由美国心脏病学会基金会发布
Objectives The purpose of this study was to identify the predictors of left ventricular (LV) recovery in patients with peripartum cardiomyopathy (PPCM) and to record rates of implantable cardioverter-defibrillator (ICD) use.Background PPCM is a rare, life-threatening disease. The use of ICDs has not been clearly understood in this patient group. Identification of the predictors of persistent LV dysfunction can help select patients at risk for sudden cardiac death. Methods A retrospective study was conducted at 2 academic centers between January 1, 1999, and December 31, 2012. Clinical and demographic variables and delivery records of patients with a diagnosis of PPCM (International Classification of Diseases, 9th Revision code 674.5) were reviewed. Improvement in LV function was noted from echocardiography reports.Results The total sample comprised 100 patients, of whom 55% were African Americans, 39% were Caucasians, and 6% were Hispanic, with a mean age of 30 +/- 6 years. Mean left ventricular ejection fraction (LVEF) at diagnosis was 28 +/- 9%. Forty-two percent of patients showed improvement in LVEF over a mean duration of 33 +/- 21 months. Postpartum diagnosis (hazard ratio: 3.0; p 0.01) and Caucasian/Hispanic race (hazard ratio: 2.2; p 0.01) were predictors of improvement in LVEF. Only 7 of the 58 patients (12%) who did not have improvement in their LVEF had an ICD implanted. There were 11 deaths, with a trend toward higher mortality in those who did not display improved LV function (15% vs. 5%; p 0.1).Conclusions More than one-third of women with PPCM improve LV function with delayed recovery noted in the majority of these patients. Caucasians and those diagnosed in the postpartum period appear to be the most likely to recover. The rate of ICD implantation for primary prevention of sudden cardiac death in this patient group is low. (C) 2014 by the American College of Cardiology Foundation