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(Circulation. 2005;111:2050-2055.)
© 2005 American Heart Association, Inc.

Heart Failure

Pregnancy-Associated Cardiomyopathy

Clinical Characteristics and a Comparison Between Early and Late Presentation

Uri Elkayam, MD; Mohammed W. Akhter, MD; Harpreet Singh, MD; Salman Khan, MD; Fahed Bitar, MD; Afshan Hameed, MD; Avraham Shotan, MD

From the Heart Failure Program, Division of Cardiovascular Medicine, and Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles.

Reprint requests to Uri Elkayam, MD, Professor of Medicine, Director of Cardiology High-Risk Pregnancy Service, Director of Heart Failure Program, Division of Cardiovascular Medicine, University of Southern California Keck School of Medicine, 1200 N State St, Room 7440, Los Angeles, CA 90033. E-mail elkayam{at}usc.edu

Received August 8, 2004; revision received January 5, 2005; accepted January 11, 2005.

Background— Cardiomyopathy associated with pregnancy was first described more than half a century ago. However, because of its rare occurrence and geographical differences, the clinical profile of this condition has remained incompletely defined.

Methods and Results— Data obtained from 123 women with a history of cardiomyopathy diagnosed during pregnancy or the postpartum period were reviewed. One hundred women met traditional criteria of peripartum cardiomyopathy; 23 were diagnosed with pregnancy-associated cardiomyopathy earlier than the last gestational month. Peripartum cardiomyopathy patients had a mean age of 31±6 years and were mostly white (67%). Common associated conditions were gestational hypertension (43%), tocolytic therapy (19%), and twin pregnancy (13%). Left ventricular ejection fraction at the time of diagnosis was 29±11% and improved to 46±14% (P0.0001) at follow-up. Normalization of left ventricular ejection fraction occurred in 54% and was more likely in patients with left ventricular ejection fraction >30% at diagnosis. Maternal mortality was 9%. A comparison between the peripartum cardiomyopathy and early pregnancy-associated cardiomyopathy groups revealed no differences in age, race, associated conditions, left ventricular ejection fraction at diagnosis, its rate and time of recovery, and maternal outcome.

Conclusions— This study helps to define the clinical profile of patients with pregnancy-associated cardiomyopathy diagnosed in the United States. Clinical presentation and outcome of patients with pregnancy-associated cardiomyopathy diagnosed early in pregnancy are similar to those of patients with traditional peripartum cardiomyopathy. These 2 conditions may represent a continuum of a spectrum of the same disease.

Key Words: cardiomyopathy • heart failure • pregnancy

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