PREGNANCY ASSOCIATED CARDIOMYOPATHY: CLINICAL PROFILE IN 137 PATIENTS DIAGNOSED IN THE UNITED STATES

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PREGNANCY ASSOCIATED CARDIOMYOPATHY: CLINICAL PROFILE IN 137 PATIENTS DIAGNOSED IN THE UNITED STATES

MW Akhter, A Shotan, A Hameed, H Singh, S Khan, U Elkayam

Los Angeles, California

BACKGROUND: Pregnancy associated cardiomyopathy (PACM) is an uncommon, but sometimes fatal form of heart failure. Because of the rarity of PACM and geographical differences in its presentation, the clinical profile of this condition has not been clearly defined.

METHODS: We reviewed records of 137 patients with PACM, either referred to our heart failure program or obtained by a national survey.

RESULTS: Clinical profile: Age-16-43 years (mean 30 ± 6); Ethnic background-Caucasians 66%, Blacks 21%, Hispanics 10%, others 3%; Gravity-1-11 (mean 2.6 ± 2.2); Index pregnancy-1st - 51%, 2nd - 20%, 3rd - 20%, 4th - 12%, 5th or more - 17%; Duration of pregnancy-20-42 weeks (mean 36 ± 5); Mode of delivery-vaginal - 50%, cesarean - 49%, abortion - 1%.

ASSOCIATED CONDITIONS: There was a strong association between PACM and history of hypertension during pregnancy (56%), use of tocolytic therapy (29%) and twin pregnancy (31%). Left ventricular ejection fraction (LVEF): LVEF at time of diagnosis was 30± 12%, 43± 15% at 6 months follow up and 45± 15% during last follow-up at an average of 26 months. Normalization of LVEF (>50%) was observed in 54% of cases. This occurred mostly within the 1st 6 months and was more likely in Caucasians, older patients (³ 30 years), patients with gestational hypertension, and those with LVEF >30 % at diagnosis. Death, transplantation and AICDs: Death was reported in 12 patients between delivery day and 9 years postpartum. 6 of these patients died suddenly. 5 patients had heart transplantation and 3 AICD implantation.

CONCLUSION: 1. Pregnancy associated cardiomyopathy in the US can occur at any age and in various ethnic groups. 2. PACM is related to 1st or 2nd pregnancy in almost 60% of cases. 3. There is a strong association between PACM and hypertension, use of tocolytic therapy and twin pregnancy. 4. Normalization of LVEF occurs in approximately half of the patients usually within first 6 months postpartum. 5. Recovery of LV function is more likely in Caucasians, patients > 30 years old, history of elevated blood pressure during pregnancy and EF >30% at time of diagnosis.

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