PDF(Pubmed)
Abstract：
BACKGROUND: Although peripartum cardiomyopathy (PPCM) is a fatal disease affecting young patients and fetuses, little is known about its recent prognosis and risk factors. This study investigated temporal trends in clinical characteristics and outcomes for PPCM in a nationwide multicenter registry.
RESULTS: The study population comprised 340 patients (mean age, 33 years) who were diagnosed with PPCM between January 2000 and September 2022 in 26 tertiary hospitals in South Korea. PPCM was defined as heart failure with left ventricular ejection fraction ≤45% and no previously known cardiac disease. The main study outcomes included time to the first occurrence of all-cause death, heart transplantation, and cardiovascular hospitalization. The diagnosis of PPCM cases increased notably during the study period (P<0.001). However, clinical outcomes showed no significant improvement (all-cause death for 10 years: 0.9% [2000-2010] versus 2.3% [2011-2022], P=0.450; all-cause death and heart transplantation for 10 years: 3.6% [2000-2010] versus 3.0% [2011-2022] P=0.520; all-cause death, heart transplantation, and cardiovascular hospitalization for 10 years: 11.7% [2000-2010] versus 19.8% [2011-2022], P=0.240). High body mass index (hazard ratio [HR], 1.106 [95% CI, 1.024-1.196]; P=0.011), the presence of gestational diabetes (HR, 5.346 [95% CI, 1.778-16.07]; P=0.002), and increased baseline left ventricular end-diastolic dimension (HR, 1.078 [95% CI, 1.002-1.159]; P=0.044) were significant risk factors for poor prognosis.
CONCLUSIONS: While the incidence of PPCM has increased over the past 20 years, the prognosis has not improved significantly. Timely management and close follow-up are necessary for high-risk patients with PPCM with high body mass index, gestational diabetes, or large left ventricular end-diastolic dimension.
RESULTS: The study population comprised 340 patients (mean age, 33 years) who were diagnosed with PPCM between January 2000 and September 2022 in 26 tertiary hospitals in South Korea. PPCM was defined as heart failure with left ventricular ejection fraction ≤45% and no previously known cardiac disease. The main study outcomes included time to the first occurrence of all-cause death, heart transplantation, and cardiovascular hospitalization. The diagnosis of PPCM cases increased notably during the study period (P<0.001). However, clinical outcomes showed no significant improvement (all-cause death for 10 years: 0.9% [2000-2010] versus 2.3% [2011-2022], P=0.450; all-cause death and heart transplantation for 10 years: 3.6% [2000-2010] versus 3.0% [2011-2022] P=0.520; all-cause death, heart transplantation, and cardiovascular hospitalization for 10 years: 11.7% [2000-2010] versus 19.8% [2011-2022], P=0.240). High body mass index (hazard ratio [HR], 1.106 [95% CI, 1.024-1.196]; P=0.011), the presence of gestational diabetes (HR, 5.346 [95% CI, 1.778-16.07]; P=0.002), and increased baseline left ventricular end-diastolic dimension (HR, 1.078 [95% CI, 1.002-1.159]; P=0.044) were significant risk factors for poor prognosis.
CONCLUSIONS: While the incidence of PPCM has increased over the past 20 years, the prognosis has not improved significantly. Timely management and close follow-up are necessary for high-risk patients with PPCM with high body mass index, gestational diabetes, or large left ventricular end-diastolic dimension.
摘要：
背景：尽管围产期心肌病（PPCM）是一种影响年轻患者和胎儿的致命疾病，对其近期预后和危险因素知之甚少。这项研究调查了全国多中心注册表中PPCM临床特征和结果的时间趋势。
结果：研究人群包括340名患者（平均年龄，33岁）的人在2000年1月至2022年9月之间在韩国的26家三级医院中被诊断出患有PPCM。PPCM被定义为左心室射血分数≤45％且先前没有已知心脏病的心力衰竭。主要研究结果包括全因死亡的首次发生时间，心脏移植,和心血管住院。在研究期间，PPCM病例的诊断显着增加（P<0.001）。然而,临床结果显示无显著改善（10年的全因死亡：0.9%[2000-2010]对2.3%[2011-2022]，P=0.450;全因死亡和心脏移植10年：3.6％[2000-2010]与3.0％[2011-2022]P=0.520;全因死亡，心脏移植,和心血管住院10年：11.7%[2000-2010]对19.8%[2011-2022]，P=0.240）。高体重指数(危险比[HR]，1.106[95%CI，1.024-1.196]；P=0.011)，妊娠期糖尿病的存在(HR，5.346[95%CI，1.778-16.07]；P=0.002），和基线左心室舒张末期尺寸增加(HR，1.078[95%CI,1.002-1.159];P=0.044)是不良预后的显著危险因素。
结论：虽然PPCM的发病率在过去20年中有所增加，预后没有明显改善。对于高体重指数的PPCM高危患者，需要及时的管理和密切的随访，妊娠期糖尿病,或左心室舒张末期尺寸大。
结果：研究人群包括340名患者（平均年龄，33岁）的人在2000年1月至2022年9月之间在韩国的26家三级医院中被诊断出患有PPCM。PPCM被定义为左心室射血分数≤45％且先前没有已知心脏病的心力衰竭。主要研究结果包括全因死亡的首次发生时间，心脏移植,和心血管住院。在研究期间，PPCM病例的诊断显着增加（P<0.001）。然而,临床结果显示无显著改善（10年的全因死亡：0.9%[2000-2010]对2.3%[2011-2022]，P=0.450;全因死亡和心脏移植10年：3.6％[2000-2010]与3.0％[2011-2022]P=0.520;全因死亡，心脏移植,和心血管住院10年：11.7%[2000-2010]对19.8%[2011-2022]，P=0.240）。高体重指数(危险比[HR]，1.106[95%CI，1.024-1.196]；P=0.011)，妊娠期糖尿病的存在(HR，5.346[95%CI，1.778-16.07]；P=0.002），和基线左心室舒张末期尺寸增加(HR，1.078[95%CI,1.002-1.159];P=0.044)是不良预后的显著危险因素。
结论：虽然PPCM的发病率在过去20年中有所增加，预后没有明显改善。对于高体重指数的PPCM高危患者，需要及时的管理和密切的随访，妊娠期糖尿病,或左心室舒张末期尺寸大。
