Circulation, Vol 81, 922-928, Copyright © 1990 by American Heart Association
MG Midei, SH DeMent, AM Feldman, GM Hutchins and KL Baughman
The clinical and pathologic features of 18 consecutive patients with
peripartum cardiomyopathy at The Johns Hopkins Hospital were examined in an
attempt to define the incidence of myocarditis and to determine its
response to immunosuppressive agents. In addition to routine studies,
patients were evaluated with echocardiography, nuclear ventriculography,
right heart catheterization, and myocardial biopsy. Fourteen of the 18
patients (78%) showed evidence of myocarditis. Of these, 10 were treated
with immunosuppressive therapy. Nine of the 10 treated patients with
myocarditis had subjective and objective improvement. Follow-up
endomyocardial biopsies in these patients showed resolution or substantial
improvement in myocarditis. Four patients with myocarditis not treated with
immunosuppressives also improved. All patients improving spontaneously
presented with congestive heart failure within 1 month of delivery and
improved dramatically within days of presentation. Four of the 18 patients
showed no evidence of myocarditis. Of these, two improved, and two
deteriorated (both requiring cardiac transplantation). None of these four
patients were treated with immunosuppressive therapy. We conclude that in
patients with peripartum cardiomyopathy, 1) the etiology remains unclear
although myocarditis was present in 78% of those with this condition, 2)
resolution of myocarditis is associated with significant improvement in
left ventricular function, 3) myocarditis may resolve spontaneously without
detectable loss of cardiac function, and 4) immunosuppressive therapy in
patients with myocarditis and persistent left ventricular dysfunction may
improve left ventricular function and prognosis.
ARTICLES
Peripartum myocarditis and cardiomyopathy
Johns Hopkins Medical Institutions, Department of Medicine, Baltimore, Maryland.
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