Abstract
Background
Peripartum cardiomyopathy (PPCM) is a potentially life-threatening dilated cardiomyopathy
that occurs in previously well women during pregnancy or postpartum. The predictors
of persistent left ventricular (LV) systolic dysfunction (LVSD) in PPCM are poorly
understood and were the subject of this study.
Methods
Patients with PPCM (n = 71), who were admitted to Beijing Friendship Hospital from
2004 to 2011, were retrospectively analyzed. Data including electrocardiographic and
echocardiographic measurements at diagnosis (baseline) and at the last follow-up visit
were collected. Data on plasma brain natriuretic peptide (BNP) and C-reactive protein
(CRP) levels were also collected at baseline. A receiver operating characteristic
curve was used to determine the cutoff values. Univariate and multivariate analyses
were used to assess the significant predictive variables for persistent LVSD.
Results
Thirty-one patients (44%) did not recover completely at the last follow-up visit (LV
nonrecovery group), and 40 patients (56%) had good LV recovery (LV recovery group).
Baseline BNP level was positively correlated with LV end-diastolic diameter (r = 0.559; P < 0.001), and inversely correlated with LV ejection fraction (LVEF) (r = −0.548; P < 0.001) and fractional shortening (r = −0.542; P < 0.001). There was no difference in CRP levels between the 2 groups. Receiver operating
characteristic curves indicated the cutoff value in terms of predicting persistent
LVSD was 34% for LVEF, 64 mm for LV end-diastolic diameter, 16% for fractional shortening,
and 1860 pg/mL for BNP. Univariate and multivariate analyses confirmed that LVEF <
34% (95% CI, 1.38-7.30; P = 0.007) and BNP > 1860 pg/mL (95% CI, 1.18-6.99; P = 0.020) were independent prognostic factors in predicting persistent LVSD.
Conclusions
LVEF and plasma BNP levels have good predictive value in long-term cardiac dysfunction.
Résumé
Introduction
La cardiomyopathie du péripartum (CMPP) est une cardiomyopathie dilatée mettant potentiellement
la vie en danger qui survient durant la grossesse ou le post-partum chez les femmes
qui étaient auparavant en bonne santé. L’objet de l’étude qui porte sur les prédicteurs
de la dysfonction systolique du ventricule gauche (DSVG) persistante lors de CMPP
est mal compris.
Méthodes
Les patients souffrant de CMPP (n = 71), qui étaient admis au Beijing Friendship Hospital
de 2004 à 2011, faisaient l’objet d’une analyse rétrospective. Les données, y compris
les mesures électrocardiographiques et échocardiographiques au moment du diagnostic
(initial) et à la dernière visite de suivi étaient recueillies. Les données sur les
concentrations plasmatiques du peptide natriurétique de type B (BNP: brain natriuretic peptide) et de la protéine C réactive étaient également recueillies au début. Une courbe
caractéristique d’efficacité du récepteur était utilisée pour déterminer les valeurs
seuils. Les analyses univariées et multivariées étaient utilisées pour évaluer les
variables prédictives significatives du DSVG.
Résultats
Trente et un patients (44 %) n’avaient pas complètement récupéré à la dernière visite
de suivi (groupe de non-récupération de la fonction ventriculaire gauche), et 40 patients
(56 %) avaient eu une bonne récupération de la fonction ventriculaire gauche (groupe
de récupération de la fonction ventriculaire gauche). La concentration initiale du
BNP était positivement corrélée au diamètre télédiastolique du ventricule gauche (r = 0,559; P < 0,001), et inversement corrélée à la fraction d’éjection ventriculaire gauche (FEVG;
r = −0,548; P < 0,001) et à la fraction de raccourcissement (r = −0,542; P < 0,001). Aucune différence dans les concentrations de la protéine C réactive n’était
observée entre les 2 groupes. Les courbes caractéristiques d’efficacité du récepteur
qui indiquaient la valeur seuil en matière de prédiction du DSVG persistant était
de 34 % pour la FEVG, de 64 mm pour le diamètre télédiastolique du ventricule gauche,
de 16 % pour la fraction de raccourcissement et de 1860 pg/ml pour le BNP. Les analyses
univariées et multivariées confirmaient que la FEVG < 34 % (intervalle de confiance
[IC] à 95 %, 1,38-7,30; P = 0,007) et que le BNP > 1860 pg/ml (IC à 95 %, 1,18-6,99; P = 0,020) étaient des facteurs pronostiques indépendants de la prédiction du DSVG
persistant.
Conclusions
La FEVG et les concentrations plasmatiques du BNP offrent une bonne valeur prédictive
de la dysfonction cardiaque à long terme.
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Article info
Publication history
Published online: August 14, 2015
Accepted:
July 2,
2015
Received:
March 20,
2015
Footnotes
See editorial by Fett and McNamara, pages 286-288 of this issue.
See page 367 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
