Peripartum cardiomyopathy: Clinical, hemodynamic, histologic and prognostic characteristics

Peripartum cardiomyopathy is defined as left ventricular dilation and failure, first developing during the third trimester of pregnancy or in the first 6 months postpartum. In an effort to characterize this syndrome in a middle class population, 14 consecutive patients with peripartum cardiomyopathy underwent a detailed history and physical examination, right heart catheterization, M-mode and two-dimensional echocardiography, radionuclide ventriculography and right ventricular endomyocardial biopsy. These patients were then observed with sequential noninvasive studies to determine prognostic indicators. Eight (57%) of these 14 patients were primiparous and an equal number first presented with heart failure concomitant with or immediately before the onset of labor. When these women were compared with 55 patients with idopathic dilated cardiomyopathy, only mean age at onset of symptoms (28.7 ± 5.7 versus 48.2 ± 13.6 years, p < 0.001) and symptom duration (4.1 ± 7.7 versus 19.0 ± 18.4 months, p < 0.001) differed between the groups. There was no difference in ven- tricular arrhythmia, left ventricular chamber size, ejection fraction or hemodynamics. Myocyte histologic findings were similar; however, myocarditis was identified in 29% of patients with peripartum cardiomyopathy and in only 9% of those with idiopathic dilated cardiomyopathy. In all patients with peripartum cardiomyopathy and myocarditis, the myocardial biopsy was performed within 1 week of onset of symptoms. Seven (50%) of the patients with peripartum cardiomyopathy had dramatic improvement within 6 weeks of follow-up, and 6 (43%) died. Survivors had a higher ejection fraction (22.8 ± 11.7 versus 10.6 ± 1.5%, p < 0.05) and smaller left ventricular cavity size (5.8 ± 1.2 versus 6.9 ± 0.7 cm, p < 0.05). Peripartum cardiomyopathy in a middle class population is hemody-namically indistinguishable from idiopathic dilated cardiomyopathy but is characterized by a high incidence of histologic myocarditis resulting in rapid, spontaneous improvement of congestive heart failure or progressive deterioration resulting in early death.