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Abstract：
Introduction Peripartum cardiomyopathy (PPCM) is defined as an idiopathic left ventricular failure with reduced ejection fraction (EF <45%) that affects women in the last month of pregnancy or in the months after giving birth. The pathophysiology remains elusive, resulting in complications with varied severity; one of the most concerning complications is thromboembolism, specifically pulmonary embolism (PE). The purpose of this study was to characterize and evaluate the real-world prevalence, predictors, and outcomes of PE in PPCM. Methods The data were derived from the National Inpatient Sample (NIS) database from January 2016 to December 2019. The primary outcomes assessed were baseline and hospital admission characteristics and comorbidities for patients with PPCM with or without PE. Outcomes for PPCM patients with PE and predictors of mortality for PPCM were also analyzed. Results PE developed in 105 of 4,582 patients with PPCM (2.3%). Patients with PPCM and PE had longer hospital stays (10.86 days ± 1.4 vs. 5.73 ± 0.2 days, p = 0.001) and total charges ($169,487 ± $39,628 vs. $86,116 ± $3,700, p = 0.001). Patients with PE had a higher burden of coagulopathy (13.3% vs. 3.0%, p = 0.01), intracardiac thrombus (6.7% vs. 1.6%, p = 0.01), and iron deficiency anemia (21.0% vs. 12.6%, p = 0.01). Patients without PE were found to have a higher burden of preeclampsia (14.7% vs. 1.9%, p = 0.01) and obstructive sleep apnea (5.4% vs. 1.0%, p = 0.045). Predictors of mortality in patients with PPCM included cardiogenic shock (aOR 13.42, 95% CI 7.50-24.03, p = 0.05), PE (aOR 6.60, 95% CI 2.506-17.39, p = 0.05), non-ST-elevation myocardial infarction (NSTEMI; aOR 3.57, 95% CI 1.35-9.44, p = 0.05), chronic kidney disease (aOR 3.23, 95% CI 1.68-6.22, p = 0.05), and atrial fibrillation (aOR 2.57; 95% CI 1.25-5.30, p = 0.05). Conclusion Although an uncommon complication, PE in PPCM demonstrates an association with higher mortality and financial burden. Along with PE, we found predictors of mortality in PPCM to include atrial fibrillation, NSTEMI, chronic kidney disease, and cardiogenic shock.
摘要：
简介围产期心肌病（PPCM）被定义为特发性左心室衰竭，射血分数降低（EF<45％），在怀孕的最后一个月或分娩后的几个月内影响妇女。病理生理学仍然难以捉摸，导致严重程度不同的并发症；最令人担忧的并发症之一是血栓栓塞，特别是肺栓塞（PE）。这项研究的目的是表征和评估真实世界的患病率，预测因子,PPCM中PE的结果。方法数据来源于2016年1月至2019年12月全国住院患者样本(NIS)数据库。评估的主要结果是有或没有PE的PPCM患者的基线和住院特征以及合并症。还分析了患有PE的PPCM患者的预后和PPCM死亡率的预测因素。结果4,582例PPCM患者中有105例发生PE（2.3％）。PPCM和PE患者的住院时间更长（10.86天±1.4vs.5.73±0.2天，p=0.001）和总费用（169,487美元±39,628美元与$86,116±$3,700，p=0.001）。PE患者的凝血功能障碍负担较高（13.3％vs.3.0%,p=0.01),心内血栓（6.7%vs.1.6%,p=0.01),和缺铁性贫血（21.0%vs.12.6%,p=0.01)。没有PE的患者被发现有更高的先兆子痫负担(14.7%vs.1.9%，p=0.01）和阻塞性睡眠呼吸暂停（5.4%vs.1.0%，p=0.045)。PPCM患者死亡率的预测因素包括心源性休克(aOR13.42,95%CI7.50-24.03,p=0.05),PE（aOR6.60，95%CI2.506-17.39，p=0.05），非ST段抬高型心肌梗死(NSTEMI;aOR3.57,95%CI1.35-9.44,p=0.05),慢性肾脏病（aOR3.23，95%CI1.68-6.22，p=0.05），和心房颤动（aOR2.57；95%CI1.25-5.30，p=0.05）。结论虽然并发症并不常见,PPCM中的PE与较高的死亡率和经济负担相关。随着PE,我们发现PPCM死亡率的预测因子包括心房颤动,NSTEMI,慢性肾病,和心源性休克.
