Differences in Clinical Profile of African-American Women With Peripartum Cardiomyopathy in the United States

Goland, Sorel; Modi, Kalgi; Hatamizadeh, Parta; Elkayam, Uri

doi:10.1016/j.cardfail.2013.03.004

Cited by 86 publications

(61 citation statements)

References 23 publications

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“…After adjustment for LV dilatation and systolic delayed diagnosis, 6 lower body mass index, 23 and black African descent. 3,6,8,28,29 Previous studies have shown that RV function at diagnosis predicts outcome among adult patients with myocarditis, 13 idiopathic dilated cardiomyopathy, [9][10][11][12] or newly diagnosed ischemic or nonischemic systolic heart failure.…”

Section: Discussionmentioning

confidence: 99%

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Right Ventricular Function in Peripartum Cardiomyopathy at Presentation Is Associated With Subsequent Left Ventricular Recovery and Clinical Outcomes

Blauwet

Delgado-Montero

Ryo

et al. 2016

Circ: Heart Failure

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P eripartum cardiomyopathy (PPCM) is a pregnancy-associated cardiomyopathy of unknown cause resulting in considerable morbidity and mortality in young, otherwise healthy women. The natural history of PPCM seems to be variable although the rarity of this disease and the inconsistent diagnostic criteria that have been used in previous case series and research studies make it difficult to accurately describe the range of disease progression. Retrospective studies of patients with PPCM in the United States have shown that mortality is as high as 18%, [1][2][3][4][5][6] and left ventricular (LV) ejection fraction (LVEF) returns to normal at 6 months to 1 year in only 40% to 62% of patients. 3,[6][7][8] See Clinical PerspectiveGiven the relatively high rates of death and persistent LV dysfunction in patients with PPCM, establishing reliable predictors of outcome is important to enable clinicians to provide optimal care for these patients. Previous retrospective studies have shown numerous factors to be associated with recovery of LV function, but none has been validated in a large prospective cohort and none has focused on right ventricular (RV) function. RV function at diagnosis has been shown to predict outcomes among patients with other types of acute cardiomyopathies, 9-14 so it seems reasonable to expect that RV function at baseline predicts LV recovery and cardiac events in patients with PPCM as well.The Investigations of Pregnancy-Associated Cardiomyopathy (IPAC) study was a multicenter prospective study of the demographics, inflammatory pathogenesis, treatment, and clinical predictors of outcome for patients with PPCM in North America.15 PPCM is a diffuse process that affects biventricular function to a variable degree, and we hypothesized that patients who manifest RV dysfunction at presentation Background-Peripartum cardiomyopathy has variable disease progression and left ventricular (LV) recovery. We hypothesized that baseline right ventricular (RV) size and function are associated with LV recovery and outcome. Methods and Results-Investigations of Pregnancy-Associated Cardiomyopathy was a prospective 30-center study of 100 peripartum cardiomyopathy women with LV ejection fraction (LVEF) <45% within 13 weeks after delivery. Baseline RV function was assessed by echocardiographic end-diastolic area, end-systolic area, fractional area change, tricuspid annular plane excursion, and RV speckle-tracking longitudinal strain. LV recovery was defined as LVEF of ≥50% at 1 year, persistent severe LV dysfunction as LVEF of ≤35%, and major events as death, transplant, or LV assist device implantation. RV measurements were feasible for 90 of the 96 patients (94%) with echocardiograms available. Mean baseline LVEF was 36±9%. RV fractional area change was <35% in 38% of patients. Of 84 patients with 1-year followup data, 63 (75%) had LV recovery and 11 (13%) had LVEF of ≤35% or a major event (4 LV assist devices and 2 deaths). Tricuspid annular plane excursion and RV strain did not predict outcome. Baseline RV fractional ...

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Section: Discussionmentioning

confidence: 99%

“…Retrospective studies of patients with PPCM in the United States have shown that mortality is as high as 18%, [1][2][3][4][5][6] and left ventricular (LV) ejection fraction (LVEF) returns to normal at 6 months to 1 year in only 40% to 62% of patients. 3,[6][7][8] …”

mentioning

confidence: 99%

Right Ventricular Function in Peripartum Cardiomyopathy at Presentation Is Associated With Subsequent Left Ventricular Recovery and Clinical Outcomes

Blauwet

Delgado-Montero

Ryo

et al. 2016

Circ: Heart Failure

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“…In a 2013 retrospective analysis of 52 black and 104 white patients in 2 centers in California and Louisiana, black patients had 34% lower rates of LV recovery (40% versus 61%; P=0.02) and a higher incidence of mortality or cardiac transplantation (P=0.03) despite similar EFs (28%) on presentation. 29 In the IPAC study, black patients presented with a lower EF (31% versus 36%; P=0.008), had a lower average EF at the 1-year follow-up (47% versus 56%; P=0003), and had a lower rate of recovery (defined as EF >50%: 59% versus 77%; P=0.03). In a North Carolina statewide registry, 7-year mortality was 24% in black patients compared with 6% in white patients.…”

Section: Racial and Geographic Differencesmentioning

confidence: 96%

“…28 A case-control study of 52 black and 104 white patients with PPCM in Southern California showed that black patients are typically younger, have a higher prevalence of hypertension, present later, and have a lower rate of recovery of left ventricular (LV) EF. 29 In a 2012 statewide population study of cases in North Carolina in 2003, the incidence of PPCM in black women was 4 times that of white women (1:1087 versus 1:4266), and the fatality rate at 5-year follow-up was also 4 times as high (24% versus 6%). 30 In summary, PPCM strikes black women more often, and these women fare worse (prognosis is described in more detail below).…”

Section: Racementioning

confidence: 99%

Peripartum Cardiomyopathy

2016

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Abstract-Peripartum cardiomyopathy is a potentially life-threatening pregnancy-associated disease that typically arises in the peripartum period and is marked by left ventricular dysfunction and heart failure. The disease is relatively uncommon, but its incidence is rising. Women often recover cardiac function, but long-lasting morbidity and mortality are not infrequent. Management of peripartum cardiomyopathy is largely limited to the same neurohormonal antagonists used in other forms of cardiomyopathy, and no proven disease-specific therapies exist yet. Research in the past decade has suggested that peripartum cardiomyopathy is caused by vascular dysfunction, triggered by late-gestational maternal hormones. Most recently, information has also indicated that many cases of peripartum cardiomyopathy have genetic underpinnings. We review here the known epidemiology, clinical presentation, and management of peripartum cardiomyopathy, as well as the current knowledge of the pathophysiology of the disease.

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“…Further black women start suffering from PC in a younger age with a higher prevalence of hypertension and a lower rate of LVEF recovery. 78 A recent meta-analysis considering 979 cases of PC, found a high prevalence of preeclampsia (22%), which is >4 times the 3-5% prevalence reported in general population. 79 However, these two conditions are pathophysiologically different and PC is not simply the consequence of severe preeclampsia.…”

Section: Epidemiologymentioning

confidence: 96%

Pregnancy and heart disease: what Internists should know

Gerloni

Panuccio²

2017

Ital J Med

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Cardiac disease can rarely complicate pregnancy (e.g., only 1 to 4% of pregnancies in the United States), but it still remains a major cause of non-obstetric maternal morbidity and mortality. 1 During pregnancy, a woman can suffer from heart failure because of a pre-existing heart disease or a new onset cardiopathy pregnancy correlated. Approximately 2% of pregnancies involve cardiac disease, and in the current era, most maternal disease is due to congenital heart disease (CHD).2 Currently cardiac surgery improvement of the last 50 years has permitted an increased number of survivors. Instead, in the past, rheumatic heart disease was the leading cause of heart failure in pregnancy.3,4 Further, with increasing maternal age, other etiologies of heart disease should not be ignored and, particularly, ischemic and hypertensive heart disease should be considered in an over forty pregnant women. 5 Physiology of normal pregnancyImportant hemodynamic changes appear during pregnancy and are responsible for heart failure in pregnant women with pre-existing heart disease. These changes begin early in pregnancy, generally during the first eight weeks, reach their peak during the late second trimester, and then remain relatively constant until delivery. 6 The plasma volume and red cell mass are the first major cardiocirculatory modification, actually they expand in the 8 th week and peak around 30 th week, with a net plasma volume gain of 1000-1600 mL, corresponding to 30-50% above baseline.7 A greater increase in intravascular volume compared to red cell mass results in the dilutional anemia of pregnancy. This aspect generally results at 30-34 weeks when plasma volume peaks in relation to red cell mass and is associated with sodium and water retention. Actually 1000 mEq of sodium and 6 liters of water are retained and distributed among amniotic fluid, fetus and intra and extracellular spaces.8 Further cardiac output increases to satisfy increase fetal and maternal metabolic needs. It can be estimated 30-50% above baseline levels during the entire pregnancy, but half of this change occurs by 8 th week. This relevant change is a consequence of blood volume augmentation, afterload reduction and maternal heart rate rise.9 Systemic Pregnancy and heart disease: what Internists should know ABSTRACTPregnant women with heart disease are increasing due to medical and surgical progress and, nowadays, congenital heart disease is the most frequent heart disease affecting these women. Pregnancy represents a considerable effort for an altered heart with negative consequences for life quality, disease progression and mortality. Risk differs a lot among patients and depends not only on the type of heart disease. Clinician should stratify risk and offer patients a correct pre-counselling and accurate follow-up. At the same time Clinician should be able to diagnose rapidly heart failure as some cardiopathies, such as peripartum cardiomyopathy, are related to pregnancy and produce symptoms that can be confused with normal pregnancy progression...

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Differences in Clinical Profile of African-American Women With Peripartum Cardiomyopathy in the United States

Cited by 86 publications

References 23 publications

Right Ventricular Function in Peripartum Cardiomyopathy at Presentation Is Associated With Subsequent Left Ventricular Recovery and Clinical Outcomes

Right Ventricular Function in Peripartum Cardiomyopathy at Presentation Is Associated With Subsequent Left Ventricular Recovery and Clinical Outcomes

Peripartum Cardiomyopathy

Pregnancy and heart disease: what Internists should know

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