Abstract
Introduction : Peripartum cardiomyopathy (PPCM) remains a major cause of maternal morbidity and mortality. PPCM is associated with acute myocardial dysfunction with a high rate of spontaneous recovery. For subjects with chronic non-ischemic cardiomyopathy, beta blockade (BB) increases left ventricular ejection fraction (LVEF), reverses remodeling and improves survival. The impact of beta blockade (BB) on recovery in acute inflammatory cardiomyopathy is less certain. We investigated the impact of BB on left ventricular recovery in a single center series of women with PPCM. Method: Thirty-six subjects with PPCM referred within the first six months post partum from 1994 to 2006 to the University of Pittsburgh Heart Failure Program were retrospectively reviewed. LVEF and LV diastolic diameter (LVEDD) were assessed by echocardiography at the time of referral (entry) and at approximately 6 and 12 months post partum. Medical therapy was assessed and LV recovery compared by treatment subset. Results: The mean age was 29.7 ± 6.9 years, gravida 2.9 ± 1.9, and para 2.3 ± 0.9. LVEF at presentation was 0.23 ± 0.09. Therapy at entry included ACE inhibitors in 95% of subjects Overall 19 (53%) subjects were not on BB at entry (Group A) while 17 were treated with BB (Group B). BB use differed based on year of presentation with 12% prior to January of 2000 and 80% post on BB therapy. Significant recovery was evident by 12 months by LVEF(0.23 ± 0.09 to 0.41 ± 0.16, p = 0.03)and LVEDD( 5.8 ± 0.9 to 5.3 ± 0.9, p = 0.01). Of note, recovery did not differ significantly by year of presentation or BB therapy(table ). Conclusion : Similar recovery was evident in subjects with PPCM treated with BB and recent historical controls not on therapy. While BB clearly plays an important role in treatment of women with chronic PPCM, they do not appear to enhance the probablity of spontaneous resolution. Impact of Beta Bockade on LV remodeling in PPCM
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