CLINICAL SPECTRUM AND OUTCOME OF PATIENTS WITH PERI-PARTUM CARDIOMYOPATHY

Abstract

Objective: To study the clinical spectrum and outcome of the patients with peripartumcardiomyopathy (PPCM) at a tertiary care hospital of Pakistan.

Methodology: In this cross-sectional study, all consecutive patients with thediagnosis of Peripartum Cardiomyopathy, admitted at Agha Khan UniversityHospital Karachi, Pakistan, during the year 2008 to 2015 were included. Data wascollected on a pre - designed questionnaire by reviewing the files. Follow up wasdone by reviewing files and by telephone calls, where required.

Results: A total of 32 patients were included in the study. Mean age was 27.4±5.8 years. Only 12% were primi-gravida. Half of them (51.5%) had no associatedCo-morbidity while 18.7% were diabetics and 28% were diagnosed to havepregnancy-induced hypertension. In 31.2% of patients symptoms were startedduring the last month of pregnancy while 68.8% had their symptom onset afterthe delivery. Main symptom was shortness of breath, present in almost all thepatients, with the signs of heart failure in 96.9% at the time of presentation).About 25% patients had no ECG changes while 71.8% showed sinus tachycardia,74.9% had severely reduced left ventricular systolic function on echocardiogramwith enlarged left ventricle in 56.2%. In the mean follow up of 24 months 1 patientdied because of heart failure with an overall mortality of 12.5%. Symptomsimproved in 59.4% and worsened in 12.5%.

Conclusion: Peripartum Cardiomyopathy usually affects young and multigravidawomen. About one third of patients have their symptom onset in the last month ofpregnancy while two thirds after the delivery. Peripartum Cardiomyopathy has ahigh maternal and fetal mortality, however more than half of the patients improve.

Key Words: Peripartum cardiomyopathy, Heart failure, Left ventricular systolicdysfunction.