2016


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2016/№5

Peripartum cardiomyopathy

Abdullaev T. A., Kurbanov N. A., Mirzarakhimova S. T., Tsoy I. A.
National Specialized Center of Cardiology, Osiyo 4, Tashkent 100052, The Republic of Uzbekistan

Keywords: peripartum dilated cardiomyopathy, course, prognosis, immunological status, ACE gene polymorphism, heart rhythm disturbances

DOI: 10.18087/rhfj.2016.5.2256

Background. Peripartum cardiomyopathy (PCMP) is a rare but potentially life-threatening form of noncoronary myocardial disease. Aim. To evaluate the association of immunological status with the insertion/deletion ACE gene polymorphism and structural and functional characteristics of LV myocardium and the nature of heart rhythm disorders in patients with PCMP. Materials and methods. 514 patients (294/158males/females) with dilated cardiomyopathy (DCMP), 68 (13.2%) of which were diagnosed with peripartum cardiomyopathy (PCMP). The immunogenetic study was performed in 50 patients with known life prognosis. Clinical status of patients was evaluated using CSS, 6-min walk test (WT), standard and 24-h ECG, transthoracic EchoCG, and the study of cell and humoral immunity (22 female patients with PCMP). Results. Mean age of patients was 28.2±0.8. Clinical manifestations of HF developed postpartum in 35 (70%) patients and in 23 of them – at 3 and more months postpartum. The 6-min walk distance was 193.3±9.8m, which corresponded to NYHA CHF FC 3.4±0.08. EchoCG showed moderate dilatation of the left heart: LV EDD, 6.5±0.1cm; LA, 4.1±0.1cm; thinning of septal walls and the LV posterior wall (0.9±0.01см). In all cases, LV EF was below 45% and the group average was 36±1.4%. The immunoregulatory index (IRI) was 22.6% lower in patients with PCMP than in healthy subjects. Analysis of genotype distribution frequency showed that 9 (42.8%) patients with PCMP had the ID genotype, 8 (38.1%) patients had the D genotype, and 4 (19.04%) patients had the II genotype (р>0.05). The allele D frequency was 26 (60.9%) cases and the I allele frequency was 15 (39%) cases (р=0.03; χ2=4.8). The obtained results showed a tendency toward a higher incidence of I/D and DD genotypes and significant predomination of the ACE gene allele D frequency in patients with PCMP. The main cause of death of PCMP patients was progression of HF with development of resistance to the administered therapy (n=13, 26%); in one case, death occurred suddenly on the background of relative well-being in one (2%) case; in one case (2%) – on the background of progressing HF and developing pulmonary embolism and cerebral thrombosis with ischemic stroke. Conclusion. Prevalence of the peripartum form in the DCMP structure is 13.2%; this form is associated with younger age. The immunological picture of PCMP is characterized with the phenomenon of immune aggression. The ID heterozygous genotype prevails with significant predomination of the D allele in patients with PCMP. Possibly, the incidence of the D allele correlates with the incidence of peripartum DCMP, which requires further investigation. In PCMP patients, the highest incidence of unfavorable outcomes was observed during the first 5 years of the follow-up. At the same time with a standard therapy for HF, complete recovery of the LV function was observed in 38% of cases within one year.
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Abdullaev T.A., Kurbanov N.A., Mirzarakhimova S.T., Tsoy I.A. Peripartum cardiomyopathy. Russian Heart Failure Journal. 2016;17 (5):350–356

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