Profile of gestational dyspnoea with focus on peripartum cardiomyopathy
Keywords:LV ejection fraction, Peripartum cardiomyopathy, Pregnancy dyspnoea
Background: Peripartum cardiomyopathy (PPCM) is even today an incompletely understood and rare disease affecting pregnant women. There have been few studies from south India, especially Kerala on PPCM.
Methods: Women who were referred from Department of Obstetrics and Gynecology from May 2010 to April 2016 for evaluation of dyspnoea during pregnancy or within 5 months of delivery were included in the study. They were screened and women with history suggestive of heart failure during peripartum period were evaluated in detail and followed up.
Results: 8760 pregnant and peripartum women presented with dyspnoea out of which 20 patients were diagnosed with PPCM. The incidence of PPCM was 1 per 2190 pregnancies. The mean left ventricular end-diastolic dimension was 58±9 mm, the mean end-systolic dimension 45±6 mm and mean left ventricular ejection fraction (LV EF) 31.45±3.73% at diagnosis. Major adverse events (MAE) occurred in 4 patients. Low baseline ejection fraction (LV EF < 30%) significantly correlated with greater incidence of adverse events.
Conclusions: The majority of pregnancy related dyspnoea is benign. Echocardiography can reliably diagnose potentially life threatening conditions and should be performed early. Echocardiography aids in both diagnosis and prognostication in PPCM. Low ejection fraction at baseline (LVEF < 30%) significantly correlates with greater incidence of major adverse events in patients with PPCM.
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