Peculiarity of Peripartum Cardiomyopathy (PPCM)
Background: PeriPartum CardioMyopathy (PPCM) is a rare, unrecognized and a life-threatening pregnancy-associated disease. It is established as left ventricular dysfunction occurring in the last month of pregnancy or the first 5 months postpartum in the absence of known aetiology or pre-existing heart disease. Recent studies suggest an incidence of 1 case per 300 live births in Haiti compared to 1 case per 3000 to 4000 live births in USA. The reasons of this variation between countries remain unknown, but still data are poor concerning incidence of PPCM because of the few population based registries. According to Sliwa et al., age, multiparity and toxaemia or pregnancy hypertension have been suggested as the main risk factors of PPCM. We have conducted a four year retrospective study to determine prevalence, clinical, echocardiographic features and risk factors of meadows cardiomyopathy in the casablanca university hospital. Results: A total of 37 patients were included in this study, all the patients were followed for at least 12 months after diagnosis. The mean age of our patients was 29 ± 5 years. The diagnosis was established antepartum in 24%, postpartum in 48% and 26% at the start of labor. The mean age of pregnancy at diagnosis was 34 ± 6 weeks of amenorrhea. History of hypertension during pregnancy and diabetes were found respectively in 3 patients, and dyslipidemia was reported in 6 patients. 8 patients had coexisting preeclampsia. Mean parity was 2.2 ± 1.8 and mean gravidity was 2.4 ± 1.6. Dyspnea and left heart failure symptoms were the most frequent signs of PPCM observed in our patients with respectively 92% and 41% for each. 3 patients died during hospitalization with a mortality rate of 11.5%, the two causes of dead were cardiogenic shock (2 patients) and one sudden death probably due to ventricular arrhythmias. Multivariate logistic regression was performed to identify independent predictors of mortality in our study. Comparing survivors to deaths, pre-eclampsia, low initial LVEF and severe mitral regurgitation at diagnosis were significant predictors associated with mortality as shown in Table 3. Conclusion: PPCM is a rare and potentially life-threatening heart disease with a significant maternal morbidity and mortality rate. Early diagnosis based on transthoracic echocardiography is essential and appropriate medical therapy should be started rapidly. Preventing lethal arrhythmias should be considered in all PPCM patients with reduced LVEF to avoid sudden cardiac deaths which are one the major cause of death in our study.