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Anatolian Current Medical Journal

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Original Article
Predictors of ejection fraction recovery and baseline differences in patients with peripartum cardiomyopathy and dilated cardiomyopathy
Abstract
Aims: Dilated cardiomyopathy (DCM) and peripartum cardiomyopathy (PPCM) are heart failure conditions with similar clinical, morphological and pathophysiological features but different underlying pathways. In PPCM and DCM patients, improvement in left ventricular ejection fraction (LVEF) varies depending on a number of factors. In this study, we aimed to determine the main differences between DCM and PPCM patients and the predictors of LVEF recovery in these patients.
Methods: This cross-sectional, observational study included 33 consecutive female patients, 10 with PPCM and 23 with DCM, attending a tertiary cardiac center between March 2020 and April 2023. We performed a retrospective analysis of some clinical data and LVEF measurements. The main outcome was accepted as EF improvement at a follow-up of at least 12 months. Binary logistic analysis was conducted to assess predictive factors linked to LVEF recovery. This involved using binary logistic regression analysis to figure out odds ratio (OR) and 95% confidence interval (CI).
Results: The PPCM group had a higher mean follow-up LVEF and LVEF value increase (p<0.001). A total of 10 patients (30%), 4 (17%) in the DCM group, and 6 (60%) in the PPCM group revealed evidence of LVEF recovery. Left atrium anteroposterior (LA-AP) diameter emerged as an independent predictor of EF recovery in the multivariate analysis (OR:0.566, 95 CI%; 0.322-0.995, p=0.048). Furthermore, the receiver operating characteristic (ROC) curve analysis identified a cutoff value of <37.5 mm for LA- AP diameter as the optimal threshold for predicting EF recovery, with 80% sensitivity and 78% specificity.
Conclusion: LA-AP diameter was a significant indicator of LVEF recovery in patients with DCM and PPCM.

Keywords : Dilated cardiomyopathy, ejection fraction recovery, peripartum cardiomyopathy

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1. Arbelo E,ProtonotariosA<span dir="RTL">,</span>Gimeno JR, et al. 2023 ESC Guidelines for the management of cardiomyopathies. <em>Eur Heart J</em>. 2023;(44):3503-3626
2. McDonagh TA,Metra M,Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. <em>Eur Heart J.</em> 2021;(42):3599-3726.
3. HeidenreichPA,Bozkurt B,AguilarD, et al. 2022 AHA/ACC/HFSA Guideline for the management of heart failure: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. <em>Circulation.</em> 2022;(145):895-1032.
4. Elliott P. Diagnosis and management of dilated cardiomyopathy. <em>Heart.</em> 2000;(84):106-112.
5. Regitz-Zagrosek V,Roos-Hesselink JW,Bauersachs J, et al. ESC Guidelines for the management of cardiovascular diseases during pregnancy. <em>Eur Heart J</em>. 2018;(39):3165-3241.
6. Bauersachs J, K&ouml;nig T, van der Meer P, et al. Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the heart failure association of the european society of cardiology study group on peripartum cardiomyopathy. <em>Eur J Heart Fail</em>. 2019;(21):827-843.
7. Davis MB, Arany Z, McNamara DM, Goland S, Elkayam U. Peripartum cardiomyopathy: JACC state-of-the-art review. <em>J Am Coll Cardiol</em>. 2020;(75):207-221.
8. Van Spaendonck-Zwarts KY, Van Tintelen JP, Van Veldhuisen DJ, et al. Peripartum cardiomyopathy as a part of familial dilated cardiomyopathy. <em>Circulation</em>. 2010;(121):2169-2175.
9. Zhang X,SunY,Zhang Y, et al. Characteristics and outcomes of heart failure with recovered left ventricular ejection fraction. <em>ESC Heart Fail</em>. 2021;(8):5383-5391.
10. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. <em>Behav Res Methods.</em> 2009;(41):1149-1160.
11. Wilcox JE, Fang JC, Margulies KB, Mann DL. Heart failure with recovered left ventricular ejection fraction: jacc scientific expert panel. <em>J Am Coll Cardiol.</em> 2020;(76):719-734.
12. Mitchell C, Rahko PS, Blauwet LA, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American society of echocardiography. <em>J Am Soc Echocardiogr</em>. 2019;(32):1-64.
13. Karaye KM, Ishaq NA, Sa&rsquo;idu H, et al. Incidence, clinical characteristics, and risk factors of peripartum cardiomyopathy in Nigeria: results from the PEACE Registry. <em>ESC Heart Fail.</em> 2020;(7):235-243.
14. Kamiya CA, Kitakaze M, Ishibashi-Ueda H, et al. Different characteristics of peripartum cardiomyopathy between patients complicated with and without hypertensive disorders. Results from the Japanese Nationwide survey of peripartum cardiomyopathy. <em>Circ J</em>. 2011;(75):1975-1981.
15. Sliwa K, Petrie MC, van der Meer P, et al. Clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy: an ESC EORP registry. <em>Eur Heart J.</em> 2020;(41):3787-3797.
16. Fett JD, Ansari AA, Sundstrom JB, Combs GF. Peripartum cardiomyopathy: a selenium disconnection and an autoimmune connection. <em>Int J Cardiol</em>. 2002;(86):311-316.
17. Ansari AA, Fett JD, Carraway RE, Mayne AE, Onlamoon N, Sundstrom JB. Autoimmune mechanisms as the basis for human peripartum cardiomyopathy. <em>Clin Rev Allergy Immunol</em>. 2002;(23):301-324.
18. van Spaendonck-Zwarts KY, Posafalvi A, van den Berg MP, et al. Titin gene mutations are common in families with both peripartum cardiomyopathy and dilated cardiomyopathy. <em>Eur Heart J</em>. 2014;(35):2165-2173.
19. Lamparter S, Pankuweit S, Maisch B. Clinical and immunologic characteristics in peripartum cardiomyopathy. <em>Int J Cardiol</em>. 2007;118(1):14-20. doi:10.1016/j.ijcard.2006.04.09018.
20. Ware JS, Li J, Mazaika E, et al. Shared genetic predisposition in peripartum and dilated cardiomyopathies. <em>N Engl J Med</em>. 2016; 374(3):233-241.
21. McNamara DM, Elkayam U, Alharethi R, et al. Clinical outcomes for peripartum cardiomyopathy in North America: results of the IPAC study. <em>J Am Coll Cardiol</em>. 2015;(66):905-914.
22. Punnoose LR, Givertz MM, Lewis EF, et al. Heart failure with recovered ejection fraction: a distinct clinical entity. <em>J Card Fail. </em>2011;(17):527-532.
23. Kalogeropoulos AP, Fonarow GC, Georgiopoulou V, et al. Characteristics and outcomes of adult outpatients with heart failure and improved or recovered ejection fraction. <em>JAMA Cardiol</em>. 2016;(1):510-518.
24. Basuray A, French B, Ky B, et al. Heart failure with recovered ejection fraction: clinical description, biomarkers, and outcomes. <em>Circulation.</em>2014;(129):2380-2387.
25. Ruwald MH, Solomon SD, Foster E, et al. Left ventricular ejection fraction normalization in cardiac resynchronization therapy and risk of ventricular arrhythmias and clinical outcomes: results from the multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy (MADIT-CRT) trial. <em>Circulation.</em> 2014;(130):2278-2286
26. Cho JY,Kim KH,Song JE, et al. Predictors of left ventricular functional recovery and their impact on clinical outcomes in patients with newly diagnosed dilated cardiomyopathy and heart failure. <em>Heart Lung Circ.</em> 2018;(27):41-49.
27. Matsumura Y, Hoshikawa-Nagai E, Kubo T, et al. Left ventricularreversere modeling in long-term (&gt;12years) survivors withidiopathic dilated cardiomyopathy. Am J Cardiol. 2013;(111):106-110.
28. Wilcox JE, Fonarow GC, Yancy CW, et al. Factors associatedwith improvement in ejection fraction in clinical practice amongpatients with heart failure: findings from improve HF. Am HeartJ. 2012;(163):49-56.
29. Aimo A, Vergaro G, Castiglione V, et al. Effect of sex on reverseremodeling in chronic systolic heart failure. JACC Heart Fail.2017;(5):735-742.
30. Sze E, Samad Z, Dunning A, et al. Impaired recovery of leftventricular function in patients with cardiomyopathy and leftbundle branch block. J Am Coll Cardiol. 2018;(71):306-317.
31. Carpenito M, Fanti D, Mega S, et al. The central role of left atriumin heart failure. Front Cardiovasc Med. 2021;(8):704-762.
32. Zhu N, Che H, Zhao X, et al. Left atrial diameter in heart failurewith left ventricular preserved, mid-range, and reduced ejectionfraction. Medicine. 2019;(98):18146.
33. Carluccio E, Dini FL, Biagioli P, et al. The &lsquo;Echo Heart FailureScore&rsquo;: an echocardiographic risk prediction score of mortality insystolic heart failure. Eur J Heart Fail. 2013;(15):868-876.
34. Bosch L, Carluccio E, Coiro S, et al. Risk stratification of asianpatients with heart failure and reduced ejection fraction: theeffectiveness of the echo heart failure score: risk stratificationof asian patients with heart failure and reduced ejectionfraction. Eur J Heart Fail. 2017;(19):1732-1735.
35. Rocha BML, Cunha GJL, Falcao Menezes LF. The burden ofiron deficiency in heart failure: therapeutic approach. J Am CollCardiol. 2018;(71):782-793.
36. Kalra PR, Cleland JGF, Petrie MC, et al. Intravenous ferricderisomaltose in patients with heart failure and iron deficiencyin the UK (IRONMAN): an investigator-initiated, prospective,randomised, open-label, blinded-endpoint trial. Lancet. 2022;(400):2199-2209.
37. Ponikowski P, Kirwan BA, Anker SD, , et al. Ferric carboxymaltosefor iron deficiency at discharge after acute heart failure: amulticentre, double-blind, randomised, controlled trial. Lancet.2020;(396):1895-1904.
38. Salah HM, Savarese G, Rosano GMC, et al. Intravenous ironinfusion in patients with heart failure: a systematic review andstudy-level meta-analysis. ESC Heart Fail. 2023;(10):1473-1480.
Article available in :
Volume 6, Issue 4, 2024
Page : 286-292
https://doi.org/10.38053/acmj.1501933
Article Information
Received : 15 Haz 2024
Accepted : 16 Tem 2024
Published : 29 Tem 2024
Corresponding Author :

Duygu İnan: Department of Cardiology, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkiye

[email protected]
Citation : İnan D, Demirtola Mammadli Aİ. Predictors of ejection fraction recovery and baseline differences in patients with peripartum cardiomyopathy and dilated cardiomyopathy. Anatolian Curr Med J. 2024;6(4):286-292.

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