Abstract 5916: Delayed Mortality in Peripartum Cardiomyopathy Indicates Need for Long-Term Follow-Up

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Kranti Gollapudi ◽  
Olaf Forster ◽  
Elena Libhaber ◽  
Kemi Tibazarwa ◽  
Winnie Tshani ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Subsequent Pregnancy ◽  
Peripartum Cardiomyopathy ◽  
Left Ventricular Ejection ◽  
Class Iii ◽  
Ventricular Ejection Fraction ◽  
The Poor ◽  
Delayed Mortality

Introduction: Peripartum cardiomyopathy (PPCM) is a rare form of cardiomyopathy occurring in women between one month antepartum and five months postpartum. It has been shown to carry a substantial risk of mortality within the first six months after diagnosis but few studies have outlined prospective long-term morbidity and mortality. The aim of this study is to assess long-term clinical outcome and mortality over a two-year period. Methods: Eighty consecutive women with PPCM were enrolled at diagnosis at a single center in a prospective study over a period of two years. Patients were started on standard heart failure therapy and detailed assessments, including echocardiography, were made at six-month intervals for twenty four months in surviving cases. Results: At baseline, the mean age of this cohort was 29.7 ± 6.4 years and 30 of 80 (38%) were in their first pregnancy. Overall, 71 (89%) patients presented in NYHA functional class III–IV at baseline and mean left ventricular ejection fraction (LVEF) was 29.7% ± 8.7%. During the two-year study period, 4 patients were lost to follow-up, 9 moved to remote areas, and 8 had a subsequent pregnancy, predisposing them to additional myocardial risk. In the remaining cases, mean LVEF was 45.1 ± 11.3, 46.3 ± 13.0 and 50.4 ± 13.5 at six, twelve, and twenty four months, respectively. Within two years, 22 women had died (28%), confirming the poor prognostic implications of PPCM. However, the majority of fatal events occurred between six and twenty four months (15 of 22; 68%). At six months, 7 of 80 (9%) patients had died. During extended follow-up, a further 15 of 69 (22%) died despite apparent recovery of left ventricular function. Conclusion: First, our findings emphasize the poor prognosis of PPCM. Furthermore, the fatality rate was higher than expected over a two-year period. The delayed mortality beyond six months observed in our study suggests the need for long-term clinical follow-up in women with PPCM.

scholarly journals Long-term Outcomes in Peripartum Cardiomyopathy

2019 ◽  
Vol 13 (1) ◽  
pp. 13-23 ◽  
Author(s):  
Madeline K Mahowald ◽  
Nivedita Basu ◽  
Latha Subramaniam ◽  
Ryan Scott ◽  
Melinda B. Davis
Keyword(s):  
Adverse Events ◽  
Left Ventricular ◽  
Subsequent Pregnancy ◽  
Peripartum Cardiomyopathy ◽  
Left Ventricular Ejection ◽  
Long Term Outcomes ◽  
Ventricular Assist ◽  
Ventricular Ejection Fraction

Background: Prior studies of Peripartum Cardiomyopathy (PPCM) are limited by short-term follow-up. Contemporary long-term outcomes and change in myocardial function over time are poorly characterized. Methods and Results: This retrospective cohort study included women with PPCM at the University of Michigan (2000-2011), with follow-up on March 31, 2017. Subsequent pregnancies were excluded. Recovery was sustained left ventricular Ejection Fraction (EF) ≥55%. Major Adverse Events (MAE) included death, cardiac transplantation, left ventricular assist device, or inotrope-dependence. A total of 59 women were included (mean [SD] age at diagnosis, 29.5 [6.8]; 28.8% Black), with a mean follow-up of 6.3 years. Recovery occurred in 22 women (37%); of these, 8 women (36%) had delayed recovery (>12 months). All cause mortality was 20% (12/59) with median survival 4.2 years; of these, 9 women (75%) died after the first year (range 2 - 10 years). MAE occurred in 19 women (32%); of these, 11 women (42%) had MAE >12 months from time of diagnosis (range 2-20 years). Deterioration in EF by >10% from the time of diagnosis occurred in 16 women (27%). This group had worse long-term outcomes, including lower final EF (mean 25 vs 42%, p=0.010), less recovery (12 vs 46%, p=0.016), and higher rates of death (38 vs 14%, p=0.046) and MAE (56 vs 23%, p=0.016). Conclusion: Women with PPCM have long-term risks of mortality, MAE, and subsequent decline in EF, even in the absence of a subsequent pregnancy. Deterioration in EF is associated with adverse events; thus, long-term management is important.

P1868Risk of arrhythmias after myocardial infarction in patients with left ventricular systolic dysfunction according to mode of revascularization: a CARISMA substudy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Thomsen ◽  
S Pedersen ◽  
P K Jacobsen ◽  
H V Huikuri ◽  
P E Bloch Thomsen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Loop Recorder ◽  
Ventricular Ejection Fraction ◽  
New Onset

Abstract Introduction The CARISMA trial was the first study to use continuous monitoring for documentation of long-term arrhythmias in post-infarction patients with left ventricular dysfunction. During the study duration (2000–2005), primary PCI (pPCI) as treatment of acute myocardial infarction was introduced approximately midway (2002) on the enrolling centres. Purpose The aim of this study was to describe the influence of mode of revascularization after myocardial infarction (AMI) on long-term risk of risk of new onset atrial fibrillation, ventricular tachyarrhythmias and brady arrhythmias. Methods The study is a sub-study on the CARISMA study population that consisted of patients with AMI and left ventricular ejection fraction ≤40%, which received an implantable loop recorder and was followed for 2 years. After exclusion of 15 patients who refused device implantation and 26 with pre-existing arrhythmias, 268 of the 312 patients were included. Choice of revascularization was made by the treating team independently of the trial and was retrospectively divided into primary percutaneous intervention (pPCI), subacute PCI (24 hours to 2 weeks after AMI), primary thrombolysis or no revascularization. Endpoints were new-onset of arrhythmias and major cardiovascular events (MACE). The Kaplan-Meier (figure 1) and Mantel-Byar methods were used for time to first event risk analysis. Results A total of 77 patients received no revascularization, whereas 49 received thrombolysis only and 142 received PCI. At two-years follow up patients treated with any PCI had a significant lower risk (0.40, n=63) of any arrhythmia compared to patients treated with trombolysis (0.60, n=30) or no revascularization (0.68, n=16) (p<0.001, unadjusted) (figure 1). Risk of MACE was significant higher in patients with any arrhythmia (0.25, n=76) compared to no arrhythmia (0.11, n=93) at two years follow-up (p=0.004, unadjusted). Figure 1 Conclusion(s) The long-term risk of new onset arrhythmias after AMI was significantly lower in patients treated with any PCI compared to patients not revascularized or treated with thrombolysis. Risk of MACE was significantly higher in patients with new onset arrhythmias compared to patients with no arrhythmias.

P1807Manifestations and outcome of cardiac sarcoidosis - does gender matter?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Simonen ◽  
J Lehtonen ◽  
M Kupari
Keyword(s):  
Cardiac Sarcoidosis ◽  
Hot Spot ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diagnostic Process ◽  
Term Outcome ◽  
Ventricular Ejection Fraction ◽  
Long Term Outcome

Abstract Background Sarcoidosis is characterized by the formation of inflammatory epithelioid-cell granulomas in various organs with cardiac involvement as its most ominous manifestation. A female preponderance in the prevalence of cardiac sarcoidosis (CS) is well known but other possible gender differences remain poorly studied. Purpose We set out to evaluate gender-related differences in the manifestations and long-term outcome of CS. Methods We reviewed the history, diagnostic procedures, details of treatment and outcome of 158 consecutive patients with histologically confirmed CS diagnosis between 1988 and 2017 at our hospital. Follow-up data were collected up to the end of 2018. Results The study population consisted of 51 men and 107 women (68%). At presentation, men were younger than women (mean age 47 years vs 51 years, p=0.045) and had more often a history of pre-existing extracardiac sarcoidosis (25% vs 10%, p=0.013). Isolated CS remained less common in men even after the complete diagnostic process (50% vs 75%, p=0.001). The main presenting CS manifestations were atrioventricular block, ventricular tachyarrhythmias and heart failure in 39%, 30% and 18% of men vs in 54%, 23% and 17% of women, respectively (p=0.183). Left ventricular ejection fraction at presentation averaged 49±11% in men and 49±13% in women (p=0.845). Troponin T was elevated more often in men at the presentation (46% vs 26%, p=0.024). At magnetic resonance imaging, pathological myocardial late gadolinium enhancement was observed in 87% of men and 84% of women (p=0.615). Myocardial “hot spot” at 18-F fluorodeoxyglucose positron emission tomography was also equally common (87% in men, 92% in women, p=0.468). An intracardiac cardioverter-defibrillator was implanted in 78% of men and 75% of women (p=0.693) and nearly all patients (99%, no gender difference) received immunosuppressive therapy. During the mean follow-up of 64 months, 10 of 51 men versus 30 of 107 women either died of a cardiac cause, suffered an aborted sudden cardiac death or underwent transplantation. The composite event-free survival did not differ between genders (Figure 1. Log-rank p=0.852). Conclusions Two thirds of CS patients are women. At disease presentation, women are older than men and their sarcoidosis is more often isolated to the heart but the clinical manifestations, diagnostic findings and long-term outcome are comparable in the two genders.

Long-Term Outcome of Iron-Induced Cardiac Disease in Patients with Thalassemia Major Treated with Combined DFP/DFO or DFO Alone.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1764-1764
Author(s):  
Maria Eliana Lai ◽  
Stefania Vacquer ◽  
Alessia Pepe ◽  
Aurelio Maggio ◽  
Maria P. Carta ◽  
...  
Keyword(s):  
High Risk ◽  
Cardiac Disease ◽  
Risk Group ◽  
Thalassemia Major ◽  
Left Ventricular ◽  
Low Risk ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Abstract We conducted a 4-yr prospective trial to evaluate the long-term effects of combined deferiprone (DFP)/deferoxamine (DFO) on reversal of cardiac complications in thalassemia major compared to those of DFO alone. Twenty-eight patients (pts) with cardiac disease requiring medication were stratified according to their risk for cardiac death. Fourteen pts were high risk, serum ferritin (SF) > 2500 ug/L on two-thirds of occasions since the onset of cardiac disease. Of those with a SF < 2500 ug/L (low risk), six had progressive decrements of left ventricular ejection fraction (LVEF). Nine high-risk pts and six low-risk pts were placed on DFP/DFO (DFP, 75 mg/kg/d divided t.i.d.; DFO, 40 – 50 mg/kg over 8 – 12 h at night 5 – 7 d/wk. The others infused DFO alone. If SF fell below 500 ug/L, DFO infusions were reduced to 2 d/wk. Cardiac follow-up (including blood work and ECG) was done at 4-m intervals. M-mode and two-dimensional echocardiograms were done at 4- to 6-m intervals. Cardiac T2* was not available at the beginning of the study. All but eight patients (3 death, 1 refusal, 2 claustrophobic, 2 pacemaker) subsequently had at least one T2* assessment. Routine lab tests were done at 1- to 6-m intervals. Blood counts were done at 7- to 10-d intervals for those taking DFP. Mean follow-up was approximately 40 m. Compliance with DFO was significantly better among low-risk pts in both treatment groups (DFP/DFO, 82% vs 61%; DFO alone, 83% vs 52%) as was that with DFP (94% vs 76%). At baseline, no statistically significant differences were observed between the SF levels, LVEFs or left ventricular shortening fractions (LVSFs) of pts on DFP/DFO or DFO alone in either risk group except for the LVEFs of the low-risk group (DFP/DFO, 56.5% +/− 5.5%; DFO alone, 65.4% +/− 5.0%; p = 0.032). In the high-risk group, four cardiac events (3 deaths, 1 worsening of CHF) occurred in the group getting DFO alone vs none in the DFP/DFO-treated group. The latter pts showed a decrease in SF and an increase in both LVEF and LVSF at the end of study (EOS). The three pts who died (at 17 to 35 m) had increased SFs. These pts were not rescued by IV DFO (98 +/− 12 mg/kg/d). The two DFO-treated pts who survived had marginally improved T2*s (1.5 to 3.0 ms and 7.6 to 8.8 ms) over the year prior to EOS. Only one of the seven evaluable pts on DFP/DFO had a T2* < 10 ms, the others averaging 19.4 +/− 6.7 ms. Among the low-risk pts, those on DFP/DFO showed a reduction in SF and an improvement in both LVEF and LVSF. Those on DFO alone had increased SF but essentially no change in LVEFs or LVSFs. Five pts on DFP/DFO had T2* evaluations. In two pts, T2* rose from 9.0 to 37 ms (38 m) and from 9.3 to 11.8 ms (17 m). The remaining three had T2* values > 20 ms at EOS. Similar results were seen in low-risk pts on DFO alone. These finding clearly support the notion that DFP/DFO has a beneficial effect upon the heart, even in well established disease. Moreover, our finding of low T2* values associated with low SF levels indicates the importance of tailoring treatment to each individual.

Can peripartum cardiomyopathy be caused by chemotherapy and radiation of breast cancer?

2013 ◽  
Vol 2 (1-2) ◽  
Author(s):  
Andreas Kyvernitakis ◽  
Ioannis Kyvernitakis ◽  
Alexander Yang ◽  
Ute-Susann Albert ◽  
Stephan Schmidt ◽  
...  
Keyword(s):  
Primary Treatment ◽  
Left Breast ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Surgical Interventions ◽  
Life Threatening ◽  
Cardiac Intensive Care

AbstractTo report on a pregnant woman with peripartum cardiomyopathy 7 years after combination chemotherapy with doxorubicine and radiation of cancer of the left breast.A 35-year old primigravida who was treated 7 years earlier with cancer of the left breast (ympT1c, ypN0, cM0), according to a neoadjuvant study protocol (GeparTrio), was transferred to our unit due to HELLP syndome at 35+5 weeks. Symptoms of cardiopulmonary decompensation occurred shortly after cesarean delivery of a healthy newborn. The patient was admitted to cardiac intensive care and treated with oxygen, diuretics and ACE inhibitors. Maternal left ventricular ejection fraction recovered within a few weeks without any surgical interventions and remained stable within 1 year of follow-up.The association between radical primary treatment of the left breast and life-threatening cardiac disease could possibly be provoked by pregnancy.

scholarly journals Predicting the development of adverse events in patients with acute coronary syndrome including genetics in the long-term follow-up

Kardiologiia ◽  
2020 ◽  
Vol 60 (4) ◽  
pp. 77-85
Author(s):  
E. A. Shmidt ◽  
S. A. Berns ◽  
A. V. Ponasenko ◽  
A. V. Klimenkova ◽  
S. A. Tumanova ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Signs ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Long Term Follow Up

Aim To study a relationship of several factors (clinical and genetical markers) with unfavorable outcomes in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in long-term follow-up.Material and methods This full-design, prospective study included 415 patients with NSTE-ACS. 266 patients were evaluated for the presence of multifocal atherosclerosis (MFA). Typing of polymorphic variants rs1041981 LTA, rs1800629 TNF, rs4986790, and rs498679 TLR4, and also rs3024491 and rs1800872 IL10 was performed. Follow-up period lasted for 67±4 months. By the end of this period, information about clinical outcomes for 396 patients became available.Results During the entire follow-up period, unfavorable outcomes were observed in 239 (57.5 %) patients with NSTE-ACS. The following clinical signs were associated with unfavorable outcomes: history of myocardial infarction, age >56 years, left ventricular ejection fraction (LV EF) ≤50 % and GRACE score ≥100, significant stenosis of brachiocephalic arteries, MFA, carriage of genotype А / А rs1041981 LTA (OR, 6.1; р=0.02) and allele А (OR, 1.9; р=0.01). According to results of a multifactorial analysis, the most significant predictors included LV EF <50 %, MFA, and carriage of genotype А / А rs1041981 LTA.Conclusion Stratification of patients with NSTE-ACS into groups of high or low risk for having an unfavorable outcome within the next 6 years is possible using the prognostic model developed and presented in this study. The model includes the following signs: LV EF <50 %, MFA, and carriage of genotype А / А rs1041981 LTA.

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