Background Peripartum cardiomyopathy (PPCM) is a dilated cardiomyopathy that affects women in the peripartum period. The incidence of PPCM in the United States is 1,100 women per year. We studied the admission of women diagnosed with PPCM to the intensive care unit (ICU) with the goal of identifying factors that increase risk for adverse outcomes. Methods This was a retrospective study of 2,286 patients with a diagnosis of PPCM admitted to a private hospital system across the United States between the years 2017 and 2021. Logistical regression analysis was utilized to identify specific patient characteristics and risk factors that were associated with admission to the ICU. Results The average age of patients was 32.13 years. The patient cohort was 39.76% black, 39.15% white, and 13.12% Hispanic. The average length of stay was 3.35 days. Preeclampsia was present in 342 (14.96%) patients, cerebral infarction in 31 (1.36%) patients, eclampsia in 48 (2.10%) patients, myocardial infarction (MI) in 52 (2.27%) patients, and HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in 24 (1.05%) patients. There was a total of 504 (22.05%) patients admitted to the ICU. Preeclampsia (adjusted odds ratio [adj. OR] 1.588, 95% confidence interval [CI] 1.215–2.074, p<0.001), eclampsia (adj. OR 3.131, 95% CI 1.718–5.708, p<0.001), cerebral infarction (adj. OR 4.381, 95% CI 2.028–9.463, p<0.001), age (adj. OR 0.967, 95% CI 0.953–0.982, p<0.001), MI (adj. OR 2.961, 95% CI 1.608–5.455, p<0.001), and HELLP syndrome (adj. OR 4.655, 95% CI 1.926–11.256, p<0.001) were all associated with increased odds of requiring ICU level of care. However, hypertension, d-dimer level, troponin level, active tobacco smoking, alcohol use, and diabetes mellitus were not associated with increased likelihood of admission to the ICU. Conclusion In our study of 2,286 women with PPCM, we found statistically significant predictors of ICU admission included age, HELLP syndrome, eclampsia, preeclampsia, MI, and cerebral infarction. This data may be useful for the early identification and triaging of patients with PPCM that require higher level of care. These results can be utilized in developing a risk score to assist in this goal. Funding Acknowledgement Type of funding sources: Private hospital(s). Main funding source(s): HCA-Riverside Community Hospital
Background: Peripartum cardiomyopathy (PPCM) is a dilated form of cardiomyopathy that occurs during the last month of pregnancy or up to five months postpartum. Approximately 1,100 women develop PPCM in the United States each year. The aim of our study is to compare the incidence of PPCM prior to the start of the Coronavirus Disease 2019 (COVID) pandemic to afterwards and to determine the impact of COVID on hospitalized patients with PPCM. Methods: This was a retrospective study of 2,286 patients with a diagnosis of PPCM who were admitted to a private hospital system across the United States between the year 2017 and year 2021. There was 1,790 patients in the pre-COVID cohort, and 496 patients in the COVID era cohort. Demographics of patients were collected, with t-test and chi square p-values utilization for statistical description. Results: The mean age of women was 32.13 years. In the COVID era cohort, the percentage of Hispanic patients was significantly higher than the pre-COVID era (16.84% vs. 12.34%, p=0.012). In the COVID era, patients were more likely to have preeclampsia (20.16% vs. 13.52%, p<0.001), HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome (2.62% vs. 0.61%, p<0.001), respiratory failure (19.56% vs. 10.57%, p<0.001), and myocardial infarction (3.63% vs. 1.90%, p=0.022). There was no significant difference in troponin and d-dimer values between the two era cohorts. The average length of stay, percentage of patients admitted to the intensive care unit (ICU), and death did not significantly differ between the pre-COVID and COVID era cohorts. Conclusion: In our study, although there was no significant difference in length of stay, ICU admission, or death in the COVID era cohort, myocardial infarction, preeclampsia, HELLP syndrome, and respiratory failure were each more prevalent in women with PPCM during the COVID era. These findings might indicate suboptimal access to outpatient and inpatient medical care during the COVID pandemic, which could have led to these more serious diagnoses.
Introduction: Pulmonary embolism is a common cause of myocardial strain. As such, patients with pulmonary embolism will have evidence of myocardial injury on laboratory assessment. This can be measured using a troponin assay. Of the patients who present with elevated troponins and pulmonary embolism, there is minimal evidence to guide the decision on whether a patient will benefit from left heart catheterization and coronary angiography. We sought to analyze troponin levels and risk factors for percutaneous coronary intervention (PCI) in a large dataset of patients hospitalized with pulmonary embolism. Methods: This was a retrospective study of 3929 patients who were admitted with pulmonary embolism in 2018 and 2019 at HCA Healthcare hospitals across the United States. Patients with other factors that could cause troponin elevation, such as a ST elevation myocardial infarction, chronic kidney disease, and sepsis, were excluded. Binary logistic regression model was utilized to examine risk factors for PCI. Results: Troponin I level was elevated in 68.9% (2707) of patients, 7.68% (208) of those patients with an elevated troponin had a left heart catheterization, and, of the patients that underwent a left heart catheterization, 26.92% (56) had PCI. The mean age of all subjects was 65.1 years and 52.4% of subjects were female. A total of 73.07% (2871) of subjects had coronary artery disease. Multivariable logistic regression showed maximum troponin value was associated with increased chance of PCI. For every ng/mL increase in troponin level, the odds of PCI increased by 2.5% (p=0.017). Patients with ischemic cardiomyopathy were 4.4-times more likely to have PCI than those without (p=0.010). Race, gender, and age were not significantly associated with risk of PCI. Conclusions: Elevated troponin is common in patients admitted with pulmonary embolism. In our dataset 7.7% of patients with elevated troponin received left heart catheterization and 26.9% of left heart catheterizations resulted in PCI. Higher troponin and known ischemic cardiomyopathy were independently associated with increased likelihood of PCI. Further analysis may help find additional factors to suggest which patients with elevated troponin should have left heart catheterization.
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