Myocarditis and long-term survival in peripartum cardiomyopathy
Myocarditis and long-term survival in peripartum cardiomyopathy
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DOI：
10.1067/mhj.2000.110091
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发表时间：
2000-11-01
影响因子：
4.8
通讯作者：
Baughman, KL
中科院分区：
文献类型：
--
作者：
Felker, GM;Jaeger, CJ;Baughman, KL
尽管心室功能自发恢复的可能性已被充分证实，但围产期心肌病（PPCM）的死亡率仍很高。PPCM中心肌炎的患病率在研究之间差异很大。本研究的目的是确定长期预后的转诊人口PPCM患者，以确定心肌炎的发病率在这个人口的内膜心肌活检，并确定临床变量与不良outcome.Methods我们分析了临床，超声心动图，血流动力学和组织学特征的42名妇女PPCM在我们的机构评估超过15年的时间。每例患者均接受了广泛的评估，包括超声心动图、肌内膜活检和右心导管插入术。通过Kaplan-Meier生存曲线和考克斯比例风险模型对数据进行分析，以确定与死亡或心脏移植联合终点相关的初始检查特征。结果3例（7%）患者死亡，3例（7%）患者在中位随访8.6年期间接受心脏移植。心肌内膜活检显示心肌炎的患病率很高（62%），但心肌炎的存在或不存在与生存率无关。在预先设定的变量评估，只有左心室每搏作功指数下降与恶化outcome.Conclusions在PPCM患者，（1）长期生存率比历史报道的更好，（2）心肌炎的患病率高，（3）左心室每搏作功指数下降与更差的临床结局。
Background The reported mortality rate of peripartum cardiomyopathy (PPCM) is high, although the potential for spontaneous recovery of ventricular function is well established. The prevalence of myocarditis in PPCM has varied widely between studies. The purposes of this study were to define the long-term prognosis in a referral population of patients with PPCM, to determine the prevalence of myocarditis on endomyocardial biopsy in this population, and to identify clinical variables associated with poor outcome.Methods We analyzed clinical, echocardiographic, hemodynamic, and histologic features of 42 women with PPCM evaluated at our institution over a 15-year period. Each patient underwent an extensive evaluation, including echocardiography, endomyocardial biopsy, and right heart catheterization. Data were analyzed to identify features at initial examination associated with the combined end point of death or cardiac transplantation by the use of Kaplan-Meier survival curves and a Cox proportional hazards model.Results Three (7%) patients died and 3 (7%) patients underwent heart transplantation during a median follow-up of 8.6 years. Endomyocardial biopsy demonstrated a high prevalence of myocarditis (62%), but the presence or absence of myocarditis was not associated with survival. Of the prespecified variables assessed, only decreased left ventricular stroke work index was associated with worsened outcome.Conclusions In patients with PPCM, (1) long-term survival is better than has been historically reported, (2) the prevalence of myocarditis is high, and (3) decreased left ventricular stroke work index is associated with worse clinical outcomes.