Elsevier

Mayo Clinic Proceedings

Volume 80, Issue 12, December 2005, Pages 1602-1606
Mayo Clinic Proceedings

ORIGINAL ARTICLE
Five-Year Prospective Study of the Incidence and Prognosis of Peripartum Cardiomyopathy at a Single Institution

https://doi.org/10.4065/80.12.1602Get rights and content

OBJECTIVE

To determine the incidence and prognosis of peripartum cardiomyopathy (PPCM) in rural Haiti.

PATIENTS AND METHODS

Prospectively identified patients with PPCM treated at the Hospital Albert Schweitzer (HAS), Deschapelles, Haiti, were included in this study. Patients who presented to HAS from February 1, 2000, to January 31, 2005, were identified through a search of the HAS PPCM Registry. Clinical and serial echocardiographic data were collected on these patients.

RESULTS

The 5-year experience confirms the high incidence of PPCM in this area, approximately 1 case per 300 live births, which is severalfold the estimated incidence in the United States (estimated 1 case per 3000 to 4000 live births). In this population, the ratio of PPCM deaths for the 5-year period was 47.1 per 100,000 births compared with the US ratio of 0.62 per 100,000 births. The mortality rate was 15.3% (15 deaths of 98 patients), and the mean follow-up was 2.2 years (range, 1 month to 5 years). Five years after the initiation of the HAS PPCM Registry search, 26 (28%) of 92 patients with PPCM observed for at least 6 months had regained normal left ventricular function. The difference in left ventricular echocardiographic features at diagnosis between deceased patients and survivors was not statistically significant: mean end-diastolic dimension (6.2 vs 5.8 cm; P=.08), ejection fraction (22% vs 25%; P=.12), and fractional shortening (16% vs 15%; P=.46). Left ventricular echocardiographic features at diagnosis were unable to predict individually who would eventually recover, although a statistically significant difference occurred at diagnosis between the recovered group and nonrecovered group for mean ejection fraction (28% vs 23%; P<.001) and fractional shortening (17% vs 14%; P=.004).

CONCLUSION

Peripartum cardiomyopathy occurs significantly more commonly in rural Haiti on a per capita basis than in the United States. Patients with PPCM have a higher mortality rate and a poorer return of normal ventricular function.

Section snippets

PATIENTS AND METHODS

All patients included in this study were identified through a search of the HAS PPCM Registry of patients who presented for treatment February 1, 2000, through January 31, 2005. The PPCM Project used the definition of PPCM outlined by Demakis and Rahimtoola,5 namely, the unexplained appearance of heart failure (HF) in a previously healthy patient during the last month of pregnancy or up to 5 months postpartum (similar to the National Institutes of Health consensus definition published

RESULTS

A total of 98 patients with PPCM were identified through the HAS PPCM Registry and were included in this study. Of these 98 patients, 92 were observed for at least 6 months.

DISCUSSION

Haiti has desperate poverty and limited medical resources. We report the natural history of PPCM in a large cohort of HIV-negative mothers from a defined catchment population in Haiti. Of the PPCM patients, 24 (24%) of 98 were primiparas. The longer observation period of 5 years has confirmed that multiparity and increased age are not as important risk factors as initially thought for this population.1, 2 The development of PPCM with the first pregnancy may hold important clues concerning the

CONCLUSION

Peripartum cardiomyopathy occurs appreciably more often in rural Haiti on a per capita basis than in the United States. In addition, patients with PPCM have high mortality rates and poor rates of return of normal left ventricular function. The reasons for these findings are unknown, although we have identified particular areas of interest for subsequent investigation.13, 14, 15, 16

Acknowledgments

The HAS PPCM Project gratefully acknowledges the assistance of Maryetta King, MD, Associate Professor of Pediatrics, Harvard Medical School, and Director of Pediatric Echocardiography at Massachusetts General Hospital, for her contribution as a medical volunteer in providing echocardiographic expertise in the early phase of this study.

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Funding from volunteer medical consultants and private contributions to humanitarian program of Hôpital Albert Schweitzer, Deschapelles, Haiti.

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