Abstract
BackgroundPeripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening complication of pregnancy. There is limited data regarding the predictors of persistent left ventricular (LV) systolic dysfunction. Recently, monocyte-to-high density lipoprotein (HDL) cholesterol ratio (MHR) has emerged as a novel indicator of inflammation and oxidative stress. We aimed to assess the predictive value of MHR on LV recovery in patients with PPCM.MethodsA total of 64 patients with PPCM who admitted to our tertiary reference hospital between 2009 and 2017 were retrospectively analyzed in this study. Demographic and clinical data, laboratory parameters and echocardiographic findings were recorded. The duration of follow-up was at least 12 months after diagnosis for all participants. Recovery of LV systolic function was defined as the presence of LV ejection fraction (LV EF) > 45%. Univariate analysis was used to determine the significant predictors of persistent LV systolic dysfunction (non-recovery). A receiver operating characteristic (ROC) curve was used to establish the cut-off values for predictors.ResultsThe mean follow-up duration was 72.1 ± 5.5 months. Of the 64 patients, 35 (55%) had persistent LVSD at their last follow-up while 29 (45%) showed LV EF improvement. The baseline MHR levels were significantly higher in the non-recovery group (P < 0.001). In univariate analysis, increased MHR levels (odds ratio:1.17; 95% confidence interval, 1.01–1.35; P < 0.001) significantly predicted LV non-recovery. Using a cut-off level of 9.73, MHR predicted persistent LV systolic dysfunction with a sensitivity of 89% and specificity of 79%. Besides, lower baseline LVEF increased WBC and CRP levels were identified as predictors of LV non-recovery.ConclusionsOur data firstly indicated that elevated MHR was a significant predictor of persistent LV systolic dysfunction in PPCM. The MHR might contribute to determining high-risk patients with PPCM.
Highlights
Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening complication of pregnancy
Exclusion criteria were having a history of cardiomyopathy, severe organic valvular heart disease, significant coronary heart disease (≥50% luminal diameter stenosis in at least 1 major coronary arteries and their branches), clinical conditions other than cardiomyopathy that could increase plasma levels of inflammatory markers such as active cancer, active infection, chronic inflammatory disease, chronic antihyperlipidemic treatment, and patients without a recorded measurement of admission laboratory parameters were excluded from this study
Recovery of left ventricular (LV) systolic function was accepted as the presence of LVEF >45%, whereas non-recovery was defined as the presence of LVEF≤45% at last follow-up visit
Summary
Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening complication of pregnancy. Peripartum cardiomyopathy (PPCM) is an uncommon but potentially life-threatening complication of pregnancy [1]. It is defined as, an occurrence of unexplained heart failure with reduced EF, usually < 45%, presenting toward the end of the pregnancy or in the first months postpartum in previously healthy women, where no other cause of heart failure is found [2]. Monocyte-to-high density lipoprotein (HDL) cholesterol ratio (MHR) has emerged as a novel and widely available inflammation and oxidative stress-based marker. In the current study, we sought to investigate the predictive value of baseline MHR on patients with PPCM
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