Five-year prospective study of the incidence and prognosis of peripartum cardiomyopathy at a single institution
Five-year prospective study of the incidence and prognosis of peripartum cardiomyopathy at a single institution
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DOI：
10.4065/80.12.1602
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发表时间：
2005-12-01
影响因子：
8.9
通讯作者：
Murphy, JG
中科院分区：
文献类型：
--
作者：
Fett, JD;Christie, LG;Murphy, JG
目的：了解海地农村围产期心肌病（PPCM）的发病率及预后。患者和方法：本研究纳入了在海地Deschapelles的Albert Schweitzer医院（HAS）治疗的前瞻性PPCM患者。2000年2月1日至2005年1月31日期间出现HAS的患者通过检索HAS PPCM Registry确定。收集这些患者的临床和连续超声心动图资料。结果：5年的经验证实了该地区PPCM的高发病率，大约每300例活产1例，是美国估计发病率的几倍（估计每3000至4000例活产1例）。在这一人群中，5年期间PPCM死亡率为47.1。相比之下，美国的这一比例为0.62 / 10万。死亡率为15.3%（15例死亡，98例），平均随访时间为2.2年（1个月至5年）。在启动HAS PPCM注册搜索5年后，观察至少6个月的92例PPCM患者中有26例（28%）恢复了正常的左心室功能。死亡患者和幸存者诊断时左心室超声心动图特征的差异无统计学意义：平均舒张末期尺寸（6.2 vs 5.8 cm, P = 0.08）、射血分数（22% vs 25%, P = 0.12）和分数缩短（16% vs 15%, P = 0.46）。诊断时的左心室超声心动图特征无法单独预测谁最终会康复，尽管在诊断时，康复组和未康复组在平均射血分数（28%对23%，P < 0.001）和分数缩短（17%对14%，P = 0.004）方面存在统计学上的显著差异。结论：围产期心肌病在海地农村的人均发生率明显高于美国。PPCM患者有较高的死亡率和较差的正常心室功能恢复。
OBJECTIVE: To determine the Incidence and prognosis of peripartum cardiomyopathy (PPCM) In rural Haiti.PATIENTS AND METHODS: Prospectively identified patients with PPCM treated at the Hospital Albert Schweitzer (HAS), Deschapelles, Haiti, were Included In this study. Patients who presented to HAS from February 1, 2000, to January 31, 2005, were identified through a search of the HAS PPCM Registry. Clinical and serial echocardiographic data were collected on these patients.RESULTS: The 5-year experience confirms the high Incidence of PPCM in this area, approximately 1 case per 300 live births, which is severalfold the estimated Incidence In the United States (estimated 1 case per 3000 to 4000 live births). In this population, the ratio of PPCM deaths for the 5-year period was 47.1. per 100,000 births compared with the US ratio of 0.62 per 100,000 births. The mortality rate was 15.3% (15 deaths of 98 patients), and the mean follow-up was 2.2 years (range, 1 month to 5 years). Five years after the Initiation of the HAS PPCM Registry search, 26 (28%) of 92 patients with PPCM observed for at least 6 months had regained normal left ventricular function. The difference In left ventricular echocardiographic features at diagnosis between deceased patients and survivors was not statistically significant: mean end-diastolic dimension (6.2 vs 5.8 cm; P = .08), ejection fraction (22% vs 25%; P = .12), and fractional shortening (16% vs 15%; P = .46). Left ventricular echocardiographic features at diagnosis were unable to predict individually who would eventually recover, although a statistically significant difference occurred at diagnosis between the recovered group and nonrecovered group for mean ejection fraction (28% vs 23%; P < .001) and fractional shortening (17% vs 14%; P = .004).CONCLUSION: Peripartum cardiomyopathy occurs significantly more commonly In rural Haiti on a per capita basis than In the United States. Patients with PPCM have a higher mortality rate and a poorer return of normal ventricular function.