Clinical Outcomes for Peripartum Cardiomyopathy in North America: Results of the IPAC Study (Investigations of Pregnancy-Associated Cardiomyopathy).
Clinical Outcomes for Peripartum Cardiomyopathy in North America: Results of the IPAC Study (Investigations of Pregnancy-Associated Cardiomyopathy).
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DOI：
10.1016/j.jacc.2015.06.1309
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发表时间：
2015-08-25
影响因子：
24
通讯作者：
IPAC Investigators
中科院分区：
文献类型：
--
作者：
McNamara DM;Elkayam U;Alharethi R;Damp J;Hsich E;Ewald G;Modi K;Alexis JD;Ramani GV;Semigran MJ;Haythe J;Markham DW;Marek J;Gorcsan J 3rd;Wu WC;Lin Y;Halder I;Pisarcik J;Cooper LT;Fett JD;IPAC Investigators
围产期心肌病（PPCM）仍然是孕产妇发病率和死亡率的主要原因。本研究旨在前瞻性评价多中心IPAC（妊娠相关性心肌病研究）研究中左心室射血分数（LVEF）的恢复和临床结局。我们招募并随访了100名产后1年的PPCM妇女。在基线和产后2、6和12个月时通过超声心动图评估LVEF。确定无主要心血管事件（死亡、移植或左心室[LV]辅助装置）的生存率。通过单变量和多变量分析评估结局的预测因素，特别是种族、左室功能障碍参数（LVEF）和重构（左室舒张末期内径[LVEDD]）。该队列为30%黑人，65%白色，5%其他;患者平均年龄为30 ± 6岁; 88%接受β受体阻滞剂，81%接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂。研究入组时的LVEF为0.35 ± 0.10，6个月时为0.51 ± 0.11，12个月时为0.53 ± 0.10。到1年时，13%的患者发生了严重事件或持续严重心肌病，LVEF <0.35，72%的患者LVEF ≥0.50。初始LVEF <0.30（p = 0.001）、LVEDD ≥6.0 cm（p < 0.001）、黑人（p = 0.001）和产后6周后分娩（p = 0.02）与12个月时LVEF较低相关。基线LVEF <0.30和LVEDD ≥6.0 cm的受试者在产后1年内均未恢复，而基线LVEF ≥0.30和LVEDD <6.0 cm的受试者有91%恢复（p < 0.00001）。在PPCM的前瞻性队列中，大多数女性康复;然而，13%的患者发生重大事件或持续严重心肌病。黑人妇女在分娩时以及产后6个月和12个月时有更多的左心室功能障碍。严重的左心室功能障碍和更大的重塑在研究开始时与恢复较少。（妊娠相关心肌病检查[IPAC]; NCT 01085955）
Peripartum cardiomyopathy (PPCM) remains a major cause of maternal morbidity and mortality. This study sought to prospectively evaluate recovery of the left ventricular ejection fraction (LVEF) and clinical outcomes in the multicenter IPAC (Investigations of Pregnancy Associated Cardiomyopathy) study. We enrolled and followed 100 women with PPCM through 1 year post-partum. The LVEF was assessed by echocardiography at baseline and at 2, 6, and 12 months post-partum. Survival free from major cardiovascular events (death, transplantation, or left ventricular [LV] assist device) was determined. Predictors of outcome, particularly race, parameters of LV dysfunction (LVEF), and remodeling (left ventricular end-diastolic diameter [LVEDD]) at presentation, were assessed by univariate and multivariate analyses. The cohort was 30% black, 65% white, 5% other; the mean patient age was 30 ± 6 years; and 88% were receiving beta-blockers and 81% angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. The LVEF at study entry was 0.35 ± 0.10, 0.51 ± 0.11 at 6 months, and 0.53 ± 0.10 at 12 months. By 1 year, 13% had experienced major events or had persistent severe cardiomyopathy with an LVEF <0.35, and 72% achieved an LVEF ≥0.50. An initial LVEF <0.30 (p = 0.001), an LVEDD ≥6.0 cm (p < 0.001), black race (p = 0.001), and presentation after 6 weeks postpartum (p = 0.02) were associated with a lower LVEF at 12 months. No subjects with both a baseline LVEF <0.30 and an LVEDD ≥6.0 cm recovered by 1 year post-partum, whereas 91% with both a baseline LVEF ≥0.30 and an LVEDD <6.0 cm recovered (p < 0.00001). In a prospective cohort with PPCM, most women recovered; however, 13% had major events or persistent severe cardiomyopathy. Black women had more LV dysfunction at presentation and at 6 and 12 months post-partum. Severe LV dysfunction and greater remodeling at study entry were associated with less recovery. (Investigations of Pregnancy Associated Cardiomyopathy [IPAC]; NCT01085955)
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影响因子：
24
作者：
Pillarisetti, Jayasree;Kondur, Ashok;Lakkireddy, Dhanunjaya
通讯作者：
Lakkireddy, Dhanunjaya
影响因子：
8.9
作者：
Fett, JD;Christie, LG;Murphy, JG
通讯作者：
Murphy, JG
影响因子：
120.7
作者：
Pearson, GD;Veille, JC;Baughman, KL
通讯作者：
Baughman, KL
影响因子：
4.3
作者：
Mathur, N. B.;Dhingra, Dhulika
通讯作者：
Dhingra, Dhulika
影响因子：
39.3
作者：
McMurray, John J. V.;Adamopoulos, Stamatis;Ponikowski, Piotr
通讯作者：
Ponikowski, Piotr