M. Drissa (Professor), A. Ayadi (Intern), H. Drissa (Professor)
{"title":"左心室（LV）缓解围产期心肌病的预测因素","authors":"M. Drissa (Professor), A. Ayadi (Intern), H. Drissa (Professor)","doi":"10.1016/j.acvdsp.2023.04.039","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Peripartum cardiomyopathy (PPCM) is a rare, life-threatening disease. The purpose was to identify the predictors of left ventricular (LV) recovery.</p></div><div><h3>Method</h3><p><span>We retrospectively reviewed 40 patients hospitalized between 2013–2022. We included women with signs of heart failure in the last month of pregnancy and up to 5 months postpartum, with absence of identifiable causes of heart failure, with LV systolic dysfunction by TEE such as depressed shortening fraction (></span> <!-->30%), EF (><!--> <!-->45%) and LV end-diastolic dimension<!--> <!-->><!--> <!-->2.7<!--> <!-->cm/m<sup>2</sup><span>. All patients were followed clinically and echocardiography at 6</span> <!-->months and over 1<!--> <!-->year.</p></div><div><h3>Results</h3><p><span><span><span><span>Thirty-two patients were multiparous, 28 had multifetal pregnancies, caesarean section was performed in 20 patients, 15 patients had severe </span>preeclampsia PPCM was discovered in antepartum in one case 5, postpartum in 35 cases with a mean time: 15 weeks after delivery. The </span>symptomatology<span><span> was dyspnea in 40 women, orthopnea in 15 cases, signs of pulmonary oedema in 20 cases and </span>right heart failure in 9 cases. TEE at admission revealed dilatation of the LV with a mean EF 26%. A RV dysfunction in 16 cases, a functional MR in 15 cases; PH in 10 cases all patients received iv </span></span>diuretics<span> in case of AHF, CEI were prescribed in 35 cases, beta blockers and MRA in 22 cases. The duration of treatment was 6</span></span> <span><span><span>months for 9 patients and over a year for others. Inotropic </span>drug and </span>circulatory support<span> were necessary in 2 cases hospital mortality rate was of 1% because of cardiogenic shock. Twenty-five patients (45%) had “any improvement” in LVEF within 6</span></span> <!-->months and 3 patients during a mean follow-up of 26<!--> <!-->months. Of these patients, 3 had complete improvement, 5 had partial recovery of LVEF. The factors associated with a higher likelihood of recovery were: postpartum diagnosis of PCCM, LVEF<!--> <!-->><!--> <!-->30%, LVEDD<!--> <!--><<!--> <!-->6<!--> <!-->cm.</p></div><div><h3>Conclusion</h3><p>PCCM is a complication of pregnancy with unknown causes. Preeclampsia and multiparity appears to be strong associations.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":null,"pages":null},"PeriodicalIF":18.0000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Predictors factor of left ventricular (LV) remission peripartum cardiomyopathy\",\"authors\":\"M. Drissa (Professor), A. Ayadi (Intern), H. Drissa (Professor)\",\"doi\":\"10.1016/j.acvdsp.2023.04.039\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>Peripartum cardiomyopathy (PPCM) is a rare, life-threatening disease. The purpose was to identify the predictors of left ventricular (LV) recovery.</p></div><div><h3>Method</h3><p><span>We retrospectively reviewed 40 patients hospitalized between 2013–2022. We included women with signs of heart failure in the last month of pregnancy and up to 5 months postpartum, with absence of identifiable causes of heart failure, with LV systolic dysfunction by TEE such as depressed shortening fraction (></span> <!-->30%), EF (><!--> <!-->45%) and LV end-diastolic dimension<!--> <!-->><!--> <!-->2.7<!--> <!-->cm/m<sup>2</sup><span>. All patients were followed clinically and echocardiography at 6</span> <!-->months and over 1<!--> <!-->year.</p></div><div><h3>Results</h3><p><span><span><span><span>Thirty-two patients were multiparous, 28 had multifetal pregnancies, caesarean section was performed in 20 patients, 15 patients had severe </span>preeclampsia PPCM was discovered in antepartum in one case 5, postpartum in 35 cases with a mean time: 15 weeks after delivery. The </span>symptomatology<span><span> was dyspnea in 40 women, orthopnea in 15 cases, signs of pulmonary oedema in 20 cases and </span>right heart failure in 9 cases. TEE at admission revealed dilatation of the LV with a mean EF 26%. A RV dysfunction in 16 cases, a functional MR in 15 cases; PH in 10 cases all patients received iv </span></span>diuretics<span> in case of AHF, CEI were prescribed in 35 cases, beta blockers and MRA in 22 cases. The duration of treatment was 6</span></span> <span><span><span>months for 9 patients and over a year for others. Inotropic </span>drug and </span>circulatory support<span> were necessary in 2 cases hospital mortality rate was of 1% because of cardiogenic shock. Twenty-five patients (45%) had “any improvement” in LVEF within 6</span></span> <!-->months and 3 patients during a mean follow-up of 26<!--> <!-->months. Of these patients, 3 had complete improvement, 5 had partial recovery of LVEF. 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引用次数: 0
摘要
围产期心肌病(PPCM)是一种罕见的危及生命的疾病。目的是确定左心室(LV)恢复的预测因素。方法回顾性分析2013-2022年间住院的40例患者。我们纳入了在妊娠最后一个月和产后5个月有心衰迹象的妇女，没有可识别的心衰原因，TEE有左室收缩功能障碍，如缩短分数降低(>30%)， EF (>45%)和左室舒张末期尺寸>2.7厘米/ m2。所有患者分别于6个月和1年多时进行临床随访和超声心动图检查。结果多胎32例，多胎妊娠28例，行剖宫产20例，重度先兆子痫15例，产前发现PPCM 1例，产后发现PPCM 35例，平均时间为产后15周。症状表现为呼吸困难40例，矫形呼吸15例，肺水肿20例，右心衰竭9例。入院时TEE显示左室扩张，平均EF为26%。右心室功能障碍16例，MR功能障碍15例;所有AHF患者均接受静脉利尿剂治疗，35例使用CEI, 22例使用受体阻滞剂和MRA。9例患者治疗时间为6个月，其余患者治疗时间超过一年。2例因心源性休克住院死亡率为1%。25例患者(45%)在6个月内LVEF“有任何改善”，3例患者在平均26个月的随访期间。其中3例完全改善，5例LVEF部分恢复。与恢复可能性较高相关的因素有:产后诊断PCCM、LVEF和gt;30%， LVEDD <6厘米。结论pccm是一种原因不明的妊娠并发症。子痫前期和多胎似乎有很强的相关性。
Predictors factor of left ventricular (LV) remission peripartum cardiomyopathy
Introduction
Peripartum cardiomyopathy (PPCM) is a rare, life-threatening disease. The purpose was to identify the predictors of left ventricular (LV) recovery.
Method
We retrospectively reviewed 40 patients hospitalized between 2013–2022. We included women with signs of heart failure in the last month of pregnancy and up to 5 months postpartum, with absence of identifiable causes of heart failure, with LV systolic dysfunction by TEE such as depressed shortening fraction (> 30%), EF (> 45%) and LV end-diastolic dimension > 2.7 cm/m2. All patients were followed clinically and echocardiography at 6 months and over 1 year.
Results
Thirty-two patients were multiparous, 28 had multifetal pregnancies, caesarean section was performed in 20 patients, 15 patients had severe preeclampsia PPCM was discovered in antepartum in one case 5, postpartum in 35 cases with a mean time: 15 weeks after delivery. The symptomatology was dyspnea in 40 women, orthopnea in 15 cases, signs of pulmonary oedema in 20 cases and right heart failure in 9 cases. TEE at admission revealed dilatation of the LV with a mean EF 26%. A RV dysfunction in 16 cases, a functional MR in 15 cases; PH in 10 cases all patients received iv diuretics in case of AHF, CEI were prescribed in 35 cases, beta blockers and MRA in 22 cases. The duration of treatment was 6months for 9 patients and over a year for others. Inotropic drug and circulatory support were necessary in 2 cases hospital mortality rate was of 1% because of cardiogenic shock. Twenty-five patients (45%) had “any improvement” in LVEF within 6 months and 3 patients during a mean follow-up of 26 months. Of these patients, 3 had complete improvement, 5 had partial recovery of LVEF. The factors associated with a higher likelihood of recovery were: postpartum diagnosis of PCCM, LVEF > 30%, LVEDD < 6 cm.
Conclusion
PCCM is a complication of pregnancy with unknown causes. Preeclampsia and multiparity appears to be strong associations.
期刊介绍：
Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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