European Heart Journal Advance Access originally published online on September 5, 2005
European Heart Journal 2006 27(4):441-446; doi:10.1093/eurheartj/ehi481
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Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients
1Department of Cardiology, Chris Hani Baragwanath Hospital, University of the Witwatersrand, PO Bertsham 2013, Johannesburg, South Africa
2Hospital Albert Schweitzer, Deschapelles, Haiti
3Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, USA
4Department of Cardiology and Angiology, Medical School Hannover, Hannover, Germany
Received 19 April 2005; revised 9 August 2005; accepted 11 August 2005; online publish-ahead-of-print 5 September 2005.
* Corresponding author. Tel: +27 11 938 1016; fax: +27 11 938 8945. E-mail address: sliwa-hahnlek{at}mdh-africa.org
Aims Peripartum cardiomyopathy (PPCM) is a disorder of unknown aetiology with a course and outcome that is largely unpredictable. We evaluated the prognostic role of multiple inflammatory markers in the plasma of a large cohort of African patients with PPCM.
Methods and results The study of 100 patients with newly diagnosed PPCM was single-centred, prospective, and longitudinal. Clinical assessment, echocardiography, and blood analysis were done at baseline and after 6 months of standard therapy. Inflammatory markers were measured at baseline only. Fifteen patients died. Left ventricular ejection fraction (LVEF) improved from 26.2±8.2 to 42.9±13.6% at 6 months (P<0.0001). However, normalization of LVEF (>50%) was only observed in 23%. Baseline levels of C-reactive protein correlated positively with baseline LV end-diastolic (rs=0.33, P=0.0026) and end-systolic (rs=0.35, P=0.0012) diameters and inversely with LVEF (rs=–0.27, P=0.015). Patients who died presented with significantly lower mean EF and higher Fas/Apo-1 plasma values (P<0.05). Fas/Apo-1 and New York Heart Association functional class (NYHA FC) predicted mortality at baseline.
Conclusion Plasma markers of inflammation were significantly elevated and correlated with increased LV dimensions and lower LVEF at presentation. Baseline Fas/Apo-1 and higher NYHA FC were the only predictors of mortality. Normalization of LVEF was only observed in 23% of this African cohort.
Key Words: Peripartum cardiomyopathy • Predictors of outcome • Inflammatory markers • Fas/Apo-1 • C-reactive protein
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