Risk stratification of women with peripartum cardiomyopathy at initial presentation: A dobutamine stress echocardiography study
Section snippets
Patient selection
Peripartum cardiomyopathy was diagnosed in 7 women between July 1996 and October 1997 at our institution. The following criteria were used for the diagnosis of peripartum cardiomyopathy: the presence of LV dysfunction (LV ejection fraction [LVEF] < 40%) in the last trimester of pregnancy or within 5 months of delivery; absence of underlying heart or valvular disease before the last trimester of pregnancy; absence of substance abuse; chronic uncontrolled hypertension; chronic systemic disease;
Results
In all, 6 women given the diagnosis of peripartum cardiomyopathy and severe resting LV dysfunction were studied. Their mean age was 31.8 years and mean LVEF was 25.3 ± 9.5% (14%-36%). The echocardiographic parameters at baseline, during dobutamine infusion demonstrating maximal inotropic contractile reserve, and at follow-up are listed in Table 1.
The peak dose of dobutamine infusion was 27 μg/kg/min (15-50 μg/kg/min). All 6 women demonstrated marked inotropic contractile reserve at peak dose of
Discussion
Although peripartum cardiomyopathy is a relatively rare disease, it can have devastating consequences with high mortality (18%-56%).6, 7 The prognostic value of a variety of clinical and echocardiographic characteristics in this disease has been studied.
Demakis et al8 studied 27 patients of which 13 had persistent cardiomegaly at the end of 6 months. The group of patients with residual cardiomegaly had a very high mortality (85%) at 4.7 years. A number of other studies also revealed LV size and
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Rest left ventricular function and contractile reserve by dobutamine stress echocardiography in peripartum cardiomyopathy
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Current author affiliations: Brigham and Women's Hospital, Boston, Massachusetts (S.D.); St Luke's-Roosevelt Hospital Center, New York, New York (S.Z., P.H., F.A.C.); Columbia University College of Physicians & Surgeons, New York, New York (S.B., J.-F.R.); University of Pennsylvania Medical Center, Philadelphia, Pennsylvania (S.B., J.-F.R.); and the Heart and Vascular Center of Florida, Cleveland Clinic, Naples, Florida. (K.G.)