Abstract：
Peripartum cardiomyopathy (PPCM) is a potentially life-threatening complication of pregnancy, but identifying patients at higher risk of this condition remains difficult.
We conducted a study to identify new risk factors associated with PPCM and predictors of poor outcomes.
This retrospective analysis included a total of 44 women with PPCM. As a control group, 79 women who gave birth around the same time as the PPCM patients and who did not have organic disease were included. A multivariate regression analysis was conducted to identify risk factors associated with PPCM and with delayed recovery.
All PPCM patients were discharged within 28 days. In comparison to the control group, PPCM patients had higher rates of preeclampsia (20.4% vs. 1.27%, P<0.001), autoimmune disease (27.3% vs. 11.4%, P = 0.018), and cesarean delivery with preterm labor (31.8% vs. 17.7%, P = 0.037). The neonates of PPCM patients had lower birth weight (2.70±0.66 kg vs. 3.21±0.57 kg, P<0.001). PPCM patients had higher levels of C-reactive protein, d-dimer, brain natriuretic peptide (BNP), and serum phosphorus, but lower levels of albumin and serum calcium (all P<0.001). In all patients with PPCM, the left ventricular ejection fraction (LVEF) returned to normal (≥50%) within 28 days after admission. Subjects with early recovery (n = 34) had lower BNP than those with delayed recovery (n = 10) (649.7 ± 526.0 pg/mL vs. 1444.1 ± 1040.8 pg/mL, P = 0.002). Multivariate regression led to a three-point score system to predict PPCM (1 point each for the presence of pericardial effusion, left ventricular dilatation, and d-dimer level ≥0.5 μg/mL). At a cutoff of ≥2, this scoring system predicted delayed recovery with 95.5% sensitivity and 96.1% specificity. The negative predictive value was 97.4% and the positive predictive value was 93.3%. Binary logistic regression indicated that PPCM patients with pulmonary hypertension, lower hemoglobin, or worse LVEF tended to require longer hospital stay (minimum 14 days).
A risk score that consists of pericardial effusion, left ventricular dilatation, and d-dimer level ≥ 0.5 μg/mL could help streamline the diagnosis of PPCM prior to confirmatory investigations. Moreover, a risk score that consists of pulmonary hypertension, lower hemoglobin and worse LVEF could help to predict poor outcomes in PPCM patients.
We conducted a study to identify new risk factors associated with PPCM and predictors of poor outcomes.
This retrospective analysis included a total of 44 women with PPCM. As a control group, 79 women who gave birth around the same time as the PPCM patients and who did not have organic disease were included. A multivariate regression analysis was conducted to identify risk factors associated with PPCM and with delayed recovery.
All PPCM patients were discharged within 28 days. In comparison to the control group, PPCM patients had higher rates of preeclampsia (20.4% vs. 1.27%, P<0.001), autoimmune disease (27.3% vs. 11.4%, P = 0.018), and cesarean delivery with preterm labor (31.8% vs. 17.7%, P = 0.037). The neonates of PPCM patients had lower birth weight (2.70±0.66 kg vs. 3.21±0.57 kg, P<0.001). PPCM patients had higher levels of C-reactive protein, d-dimer, brain natriuretic peptide (BNP), and serum phosphorus, but lower levels of albumin and serum calcium (all P<0.001). In all patients with PPCM, the left ventricular ejection fraction (LVEF) returned to normal (≥50%) within 28 days after admission. Subjects with early recovery (n = 34) had lower BNP than those with delayed recovery (n = 10) (649.7 ± 526.0 pg/mL vs. 1444.1 ± 1040.8 pg/mL, P = 0.002). Multivariate regression led to a three-point score system to predict PPCM (1 point each for the presence of pericardial effusion, left ventricular dilatation, and d-dimer level ≥0.5 μg/mL). At a cutoff of ≥2, this scoring system predicted delayed recovery with 95.5% sensitivity and 96.1% specificity. The negative predictive value was 97.4% and the positive predictive value was 93.3%. Binary logistic regression indicated that PPCM patients with pulmonary hypertension, lower hemoglobin, or worse LVEF tended to require longer hospital stay (minimum 14 days).
A risk score that consists of pericardial effusion, left ventricular dilatation, and d-dimer level ≥ 0.5 μg/mL could help streamline the diagnosis of PPCM prior to confirmatory investigations. Moreover, a risk score that consists of pulmonary hypertension, lower hemoglobin and worse LVEF could help to predict poor outcomes in PPCM patients.
摘要：
背景：围产期心肌病（PPCM）是一种潜在的危及生命的妊娠并发症，但是确定这种疾病风险较高的患者仍然很困难。
目的：我们进行了一项研究，以确定与PPCM相关的新危险因素和不良结局的预测因素。
方法：本回顾性分析共纳入44例PPCM患者。作为对照组,包括79名与PPCM患者同时分娩且没有器质性疾病的妇女。进行多元回归分析以确定与PPCM和延迟恢复相关的危险因素。
结果：所有PPCM患者均在28天内出院。与对照组相比，PPCM患者先兆子痫的发生率较高（20.4%vs.1.27%，P<0.001)，自身免疫性疾病（27.3%vs.11.4%,P=0.018),和剖宫产早产(31.8%vs.17.7%,P=0.037)。PPCM患者的新生儿出生体重较低（2.70±0.66kgvs.3.21±0.57kg,P<0.001)。PPCM患者的C反应蛋白水平较高，D-二聚体,脑钠肽（BNP），和血清磷，但白蛋白和血清钙水平较低（均P<0.001）。在所有PPCM患者中，入院后28天内左心室射血分数(LVEF)恢复正常(≥50%).早期恢复的受试者（n=34）的BNP低于延迟恢复的受试者（n=10）（649.7±526.0pg/mLvs.1444.1±1040.8pg/mL,P=0.002)。多变量回归导致三点评分系统来预测PPCM（对于心包积液的存在，每个1分，左心室扩张,d-二聚体水平≥0.5μg/mL)。在≥2的临界值时，该评分系统以95.5％的灵敏度和96.1％的特异性预测延迟恢复。阴性预测值为97.4%,阳性预测值为93.3%。二元logistic回归分析显示PPCM患者合并肺动脉高压,低血红蛋白，或更糟糕的LVEF往往需要更长的住院时间（至少14天）。
结论：由心包积液组成的风险评分，左心室扩张,d-二聚体水平≥0.5μg/mL有助于简化确诊前PPCM的诊断。此外，由肺动脉高压组成的风险评分，较低的血红蛋白和较差的LVEF可能有助于预测PPCM患者的不良结局.
目的：我们进行了一项研究，以确定与PPCM相关的新危险因素和不良结局的预测因素。
方法：本回顾性分析共纳入44例PPCM患者。作为对照组,包括79名与PPCM患者同时分娩且没有器质性疾病的妇女。进行多元回归分析以确定与PPCM和延迟恢复相关的危险因素。
结果：所有PPCM患者均在28天内出院。与对照组相比，PPCM患者先兆子痫的发生率较高（20.4%vs.1.27%，P<0.001)，自身免疫性疾病（27.3%vs.11.4%,P=0.018),和剖宫产早产(31.8%vs.17.7%,P=0.037)。PPCM患者的新生儿出生体重较低（2.70±0.66kgvs.3.21±0.57kg,P<0.001)。PPCM患者的C反应蛋白水平较高，D-二聚体,脑钠肽（BNP），和血清磷，但白蛋白和血清钙水平较低（均P<0.001）。在所有PPCM患者中，入院后28天内左心室射血分数(LVEF)恢复正常(≥50%).早期恢复的受试者（n=34）的BNP低于延迟恢复的受试者（n=10）（649.7±526.0pg/mLvs.1444.1±1040.8pg/mL,P=0.002)。多变量回归导致三点评分系统来预测PPCM（对于心包积液的存在，每个1分，左心室扩张,d-二聚体水平≥0.5μg/mL)。在≥2的临界值时，该评分系统以95.5％的灵敏度和96.1％的特异性预测延迟恢复。阴性预测值为97.4%,阳性预测值为93.3%。二元logistic回归分析显示PPCM患者合并肺动脉高压,低血红蛋白，或更糟糕的LVEF往往需要更长的住院时间（至少14天）。
结论：由心包积液组成的风险评分，左心室扩张,d-二聚体水平≥0.5μg/mL有助于简化确诊前PPCM的诊断。此外，由肺动脉高压组成的风险评分，较低的血红蛋白和较差的LVEF可能有助于预测PPCM患者的不良结局.
