CLINICAL SPECTRUM AND OUTCOME OF PATIENTS WITH PERI-PARTUM CARDIOMYOPATHY

Objective: To study the clinical spectrum and outcome of the patients with peripartum cardiomyopathy (PPCM) at a tertiary care hospital of Pakistan. Methodology: In this cross-sectional study, all consecutive patients with the diagnosis of Peripartum Cardiomyopathy, admitted at Agha Khan University Hospital Karachi, Pakistan, during the year 2008 to 2015 were included. Data was collected on a pre - designed questionnaire by reviewing the files. Follow up was done by reviewing files and by telephone calls, where required. Results: A total of 32 patients were included in the study. Mean age was 27.4 +/- 5.8 years. Only 12% were primi-gravida. Half of them (51.5%) had no associated Co-morbidity while 18.7% were diabetics and 28% were diagnosed to have pregnancy-induced hypertension. In 31.2% of patients symptoms were started during the last month of pregnancy while 68.8% had their symptom onset after the delivery. Main symptom was shortness of breath, present in almost all the patients, with the signs of heart failure in 96.9% at the time of presentation). About 25% patients had no ECG changes while 71.8% showed sinus tachycardia, 74.9% had severely reduced left ventricular systolic function on echocardiogram with enlarged left ventricle in 56.2%. In the mean follow up of 24 months 1 patient died because of heart failure with an overall mortality of 12.5%. Symptoms improved in 59.4% and worsened in 12.5%. Conclusion: Peripartum Cardiomyopathy usually affects young and multigravida women. About one third of patients have their symptom onset in the last month of pregnancy while two thirds after the delivery. Peripartum Cardiomyopathy has a high maternal and fetal mortality, however more than half of the patients improve.