| BackgroundPeripartum cardiomyopathy is a cardiovascular disease characterized by enlarged left ventricular diameter and left ventricular systolic dysfunction occurring at the end of pregnancy or within 5 months after delivery.Its etiology and pathogenesis are still unclear,and may be related to factors such as advanced age,multiple gestations,genetic predisposition,gestational hypertension,and diabetes.According to the 2018 guidelines of European Society of Cardiology,the incidence of peripartum cardiomyopathy varies greatly from region,cultural background,and race,ranging from 1/300 to 1/4000.According to latest reports,the incidence of peripartum cardiomyopathy in the United States is rising in recent years,while in China,with the rapid development of medicine,the implementation of the two-child policy,the maturity of assisted reproductive.technology,the proportion of advanced maternal age,polyembryony,gestational hypertension,diabetes,is increasing yearly,thereby the incidence of peripartum cardiomyopathy also showing an upward trend.In recent years,with the deepening of etiology research,the epidemiological mechanism of peripartum cardiomyopathy has been further recognized,and the theory of "two hit model" has been put forward,however,the basic treatment for peripartum cardiomyopathy remains standardized heart failure drug treatment.Moreover,according to relevant literature reports,about one half patients of the peripartum cardiomyopathy recovered completely in left ventricular structure and systolic function after standardized heart failure drug treatment.However,the data on the recovery of peripartum cardiomyopathy patients after treatment is rare in Chinese population.According to reports,even if given standardized heart failure drug treatment,there is about 50%of patients with peripartum cardiomyopathy only achieved partial recovery,which seriously affecting the quality of life in these patients,and bringing heavy economic burden for family and society.The mortality of peripartum cardiomyopathy varies in different research reports,about 1.3%-24%,which is influenced by many factors such as cultural background,local medicine condition etc.Thereby we designed this study to provide evidence-based data for the diagnosis,treatment and prognosis of peripartum cardiomyopathy in our population by summarizing the treatment and recovery of peripartum cardiomyopathy patients admitted to our hospital in the past 8 years.Objective1.To summarized the use of neuroendocrine antagonists in peripartum cardiomyopathy patients in our hospital and its prognosis.2.To investigate the factors affecting left ventricular end-diastolic diameter and left ventricular ejection fraction in patients with peripartum cardiomyopathy.3.To explore the factors affecting the recovery of left ventricular end-diastolic diameter and left ventricular ejection fraction in peripartum cardiomyopathy afiter standardized heart failure drug treatment.Methods1.Case collection and analysis:The hospitalization data of patients with peripartum cardiomyopathy who met the inclusion criteria from January 01,2010 to August 31,2018 were collected,including:age,parity,singleton or twin gestation,with or without gestational hypertension,cardiac function grading(NYHA classification),onset time of the disease,mean systolic blood pressure,mean diastolic blood pressure,mean heart rate,systolic pressure range,diastolic pressure range,heart rate range,The results of laboratory tests include:white blood cell count(WBC),neutrophil count(NEU),red blood cell count(RBC),hemoglobin(Hb),platelet count(PLT),homocysteine(Hcy),lactate dehydrogenase(LDH),creatine kinase (CK),NT-pro BNP.Echocardiographic parameters include:left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDd).2.Outpatient follow-up data:Echocardiographic reports and laboratory test reports of outpatients were collected after discharge from the hospital.LVEDd,LVEF,and NT-pro BNP measured in the follow-up period were recorded.Both the use of oral neuroendocrine antagonists and NYHA class after discharge was acquired by telephone contact to patients.3.Group:(1)Recovery group(group A):At the end of follow-up,the left ventricular diameter was less than or equal to 50 mm,and the left ventricular ejection fraction was greater than or equal to 50%.(2)Partial recovery group(group B):At the end of follow-up,the left ventricular end-diastolic diameter decreased from the baseline value.The baseline value of the ejection fraction increased by more than 10%but did not return to normal levels.(3)Group C:At the end of follow-up,the ejection fraction increased by less than 10%or no significant change from the baseline value,or the left ventricular ejection fraction decreased from the baseline value,with or without left ventricular end-diastolic diameter change,or deceased cases.Research result1.A total of 55 patients were enrolled in the study,with an average age of 29.58± 5.73 years,of which 22(40.0%)with gestational hypertension,9(16.4%)with twin pregnancy,32(58.2%)for primipara,28(50.9%)NYHA class IV,22(40.0%)NYHA class Ⅲ,all patients were given standardized heart failure drug treatment,of which the use rate of ACEI/ARB was 80.0%,The use rate of β blockers was 94.5%,the use rate of aldosterone receptor antagonists was 78.1%,and the average follow-up time was 26.52±3.19 months.After treatment,37 cases(67.3%)had cardiac function recovery to NYHA class I,7 Case(12.7%)to NYHA class Ⅱ,6 cases died,and the mortality was 10.9%.2.Group:31 cases(56.4%)in the group A,15 cases(27.3%)in the group B,9 cases(16.3%)in the group C,all the patients were treated with individualized standardized heart failure drug treatment,the difference in the use of rate of neuroendocrine antagonist among three groups was not statistically significant.3.Differences in Baseline laboratory data among the three groups:Homocysteine in group A,group B and the group C showed an upward trend,and the difference was statistically significant(p=0.014).Compared with the group A and group B,the troponin I of group C were significantly increased(p = 0.011),and the NT-pro BNP of group C were significantly higher than the group A and group B(p<0.001).There were no significant differences in WBC,NEU,HB,PLT,RBC,CK,and LDH among three groups.4.Differences in general data among the three groups:There were no significant differences in age,heart rate range,mean heart rate,systolic blood pressure range,diastolic pressure range among three groups(p>0.05).Compared with the group A and group B,the patients in group C tend to postpartum onset,the difference was statistically significant(p<0.001).Compared with the group B and group C,the mean systolic blood pressure in group A was significantly increased(p<0.001).Compared with group A and group B,the baseline LVEF in the group C is significantly decreased(p = 0.003),and the baseline LVEDd was significantly enlarged(p<0.001).5.Influencing factors of baseline-LVEF:Baseline-LVEF negatively correlated with the RBC(r=-0.284,p=0.003),negatively correlated with hemoglobin.(r=-0.260,p=0.007),negatively correlated with homocysteine(r=-0.389,p=0.005),negatively correlated with NT-pro BNP(r=-0.295,p=0.004),negatively correlated with the mean heart rate(r=-0.204,p=0.034),negatively correlated with the onset time(r =-0.335,p<0.001),Multiple linear regression analysis found that NT-pro BNP,onset time,and homocysteine strongly correlated with baseline-LVEF.6.Influencing factors of baseline LVEDd:Baseline LVEDd positively correlated with the RBC(r=0.278,p=0.004),positively correlated with hemoglobin(r=0.226,p=0.020),positively correlated with homocysteine(r=0.420,p=0.002),positively correlated with troponin I(r=0.396,p=0.006),and baseline LVEDd negatively correlated with LDH(r=-0.213,p=0.041),negatively correlated with the baseline-LVEF(r = 0.282,p = 0.003),multiple linear regression analysis showed that homocysteine strongly correlated with baseline LVEDd.7.Influencing factors of final-LVEF:final-LVEF negatively correlated with RBC(r =-0.243,p = 0.015),negatively correlated with homocysteine(r =-0.324,p=0.028),negatively correlated with cardiac troponin I(r=-280,p=0.013),negatively correlated with the onset time(r=-0396,p<0.001),and negatively correlated to baseline LVEDd(r=-0.484,p<0.001),negatively correlated with baseline-LVEF(r=0.262,p=0.008),positively correlated with age(r=0.275,p=0.043),and positively correlated with mean systolic blood pressure(r=0.341,p<0.001),positively correlated with diastolic pressure difference(r=0.276,p=0.005).Multiple linear regression analysis showed that baseline LVEDd strongly correlated with final-LVEF.8.Influencing factors of final LVEDd:final LVEDd positively correlated with the RBC(r=0.295,p=0.020),positively correlated with troponin I(r=0.461,p =0.001),positively correlated with homocysteine(r = 0.708,p<0.001),positively correlated with baseline LVEDd,(r = 0.727,p<0.001),and final LVEDd negatively correlated with age(r =-0.320,p=0.011),negatively correlated with systolic pressure range(r=-0.254,p=0.044),negatively correlated with mean systolic pressure(r=0.252,p=0.046),negatively correlated with the diastolic pressure range(r =-0.283,p=0.024),multiple linear regression showed that baseline LVEDd,troponin I strongly correlated with final LVEDd9.Influencing factors of LVEF-range:LVEF-range positively correlated with NT-pro BNP(r=0.247,p=0.025),and LVEF-range negatively correlated with baseline-LVEF(r=-0.531,p<0.001),negatively correlated with hemoglobin(r=-0.213,p=0.037).Multiple linear regression showed that baseline-LVEF strongly correlated with LVEF-range.10.Influencing factors of LVEDd range:LVEDd range negatively correlated with WBC(r =-0.333,p = 0.001),negatively correlated with NEU(r =-0.267,p=0.009),negatively correlated with troponin I(r=-0.318,p=0.006),negatively correlated with LDH(r=-0.369,p=0.006),negatively correlated with NT-pro BNP(r--0.266,p=0.016),negatively correlated mean diastolic pressure(r=-0.272,p=0.007),negatively correlated mean heart rate(r=-0.283),p=0.005),and LVEDd range positively correlated with baseline LVEDd(r=0.363,p<0.001),positively correlated with age(r=0.381,p<0.001),positively correlated with mean systolic blood pressure(r=0.342,p=0.032),multiple linear regression showed that baseline LVEDd strongly correlated with LVEDd range.Conclusions1.Peripartum cardiomyopathy can be cured in about one half patients after standardized heart failure drug treatment,but there is still a certain mortality rate.2.NT-proBNP,onset time,and homocysteine are independent influencing factors of baseline left ventricular ejection fraction of peripartum cardiomyopathy.3.Homocysteine is independent influencing factor of the baseline left ventricular end-diastolic diameter of peripartum cardiomyopathy.4.In the premise of standardized heart failure drug treatment,the baseline-LVEF,baseline LVEDd,cardiac troponin I are independent influencing factors of the recovery of systolic function and structure of peripartum cardiomyopathy. |
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