Peripartum cardiomyopathy: Inflammatory markers as predictors of outcome in 100 prospectively studied patients

Aims: Peripartum cardiomyopathy (PPCM) is a disorder of unknown aetiology with a course and outcome that is largely unpredictable. We evaluated the prognostic role of multiple inflammatory markers in the plasma of a large cohort of African patients with PPCM. Methods and results: The study of 100 patients with newly diagnosed PPCM was single-centred, prospective, and longitudinal. Clinical assessment, echocardiography, and blood analysis were done at baseline and after 6 months of standard therapy. Inflammatory markers were measured at baseline only. Fifteen patients died. Left ventricular ejection fraction (LVEF) improved from 26.2 ± 8.2 to 42.9 ± 13.6% at 6 months (P < 0.0001. However, normalization of LVEF (>50%) was only observed in 23%. Baseline levels of C-reactive protein correlated positively with baseline LV end-diastolic (rs = 0.33, P = 0.0026) and end-systolic (rs = 0.35, P = 0.0012) diameters and inversely with LVEF (rs = -0.27, P = 0.015). Patients who died presented with significantly lower mean EF and higher Fas/Apo-1 plasma values (P < 0.05). Fas/Apo-1 and New York Heart Association functional class (NYHA FC) predicted mortality at baseline. Conclusion: Plasma markers of inflammation were significantly elevated and correlated with increased LV dimensions and lower LVEF at presentation. Baseline Fas/Apo-1 and higher NYHA FC were the only predictors of mortality. Normalization of LVEF was only observed in 23% of this African cohort. © The European Society of Cardiology 2005. All rights reserved.