Electrocardiographic findings in peripartum cardiomyopathy

For the IPAC Investigators

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: There is limited data on electrocardiographic (ECG) abnormalities and their prognostic significance in women with peripartum cardiomyopathy (PPCM). We sought to characterize ECG findings in PPCM and explore the association of ECG findings with myocardial recovery and clinical outcomes. Hypothesis: We hypothesized that ECG indicators of myocardial remodeling would portend worse systolic function and outcomes. Methods: Standard 12-lead ECGs were obtained at enrollment in the Investigations of Pregnancy-Associated Cardiomyopathy study and analyzed for 88 women. Left ventricular ejection fraction (LVEF) was measured by echocardiography at baseline, 6 months, and 12 months. Women were followed for clinical events (death, mechanical circulatory support, and/or cardiac transplantation) until 1 year. Results: Half of women had an “abnormal” ECG, defined as atrial abnormality, ventricular hypertrophy, ST-segment deviation, and/or bundle branch block. Women with left atrial abnormality (LAA) had lower LVEF at 6 months (44% vs 52%, P = 0.02) and 12 months (46% vs 54%, P = 0.03). LAA also predicted decreased event-free survival at 1 year (76% vs 97%, P = 0.008). Neither left ventricular hypertrophy by ECG nor T-wave abnormalities predicted outcomes. A normal ECG was associated with recovery in LVEF to ≥50% (84% vs 49%, P = 0.001) and event-free survival at 1 year (100% vs 85%, P = 0.01). Conclusions: ECG abnormalities are common in women with PPCM, but a normal ECG does not rule out the presence of PPCM. LAA predicted lower likelihood of myocardial recovery and event-free survival, and a normal ECG predicted favorable event-free survival.

Original languageEnglish (US)
JournalClinical Cardiology
DOIs
StatePublished - Jan 1 2019

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Peripartum Period
Cardiomyopathies
Disease-Free Survival
Stroke Volume
Bundle-Branch Block
Left Ventricular Hypertrophy
Heart Transplantation
Hypertrophy
Echocardiography
Electrocardiography
Pregnancy

Keywords

  • electrocardiography
  • maternal-fetal health
  • outcomes
  • peripartum cardiomyopathy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Electrocardiographic findings in peripartum cardiomyopathy. / For the IPAC Investigators.

In: Clinical Cardiology, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: There is limited data on electrocardiographic (ECG) abnormalities and their prognostic significance in women with peripartum cardiomyopathy (PPCM). We sought to characterize ECG findings in PPCM and explore the association of ECG findings with myocardial recovery and clinical outcomes. Hypothesis: We hypothesized that ECG indicators of myocardial remodeling would portend worse systolic function and outcomes. Methods: Standard 12-lead ECGs were obtained at enrollment in the Investigations of Pregnancy-Associated Cardiomyopathy study and analyzed for 88 women. Left ventricular ejection fraction (LVEF) was measured by echocardiography at baseline, 6 months, and 12 months. Women were followed for clinical events (death, mechanical circulatory support, and/or cardiac transplantation) until 1 year. Results: Half of women had an “abnormal” ECG, defined as atrial abnormality, ventricular hypertrophy, ST-segment deviation, and/or bundle branch block. Women with left atrial abnormality (LAA) had lower LVEF at 6 months (44{\%} vs 52{\%}, P = 0.02) and 12 months (46{\%} vs 54{\%}, P = 0.03). LAA also predicted decreased event-free survival at 1 year (76{\%} vs 97{\%}, P = 0.008). Neither left ventricular hypertrophy by ECG nor T-wave abnormalities predicted outcomes. A normal ECG was associated with recovery in LVEF to ≥50{\%} (84{\%} vs 49{\%}, P = 0.001) and event-free survival at 1 year (100{\%} vs 85{\%}, P = 0.01). Conclusions: ECG abnormalities are common in women with PPCM, but a normal ECG does not rule out the presence of PPCM. LAA predicted lower likelihood of myocardial recovery and event-free survival, and a normal ECG predicted favorable event-free survival.",
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author = "{For the IPAC Investigators} and Honigberg, {Michael C.} and Uri Elkayam and Navin Rajagopalan and Kalgi Modi and Briller, {Joan E.} and Drazner, {Mark H} and Wells, {Gretchen L.} and McNamara, {Dennis M.} and Givertz, {Michael M.}",
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AU - For the IPAC Investigators

AU - Honigberg, Michael C.

AU - Elkayam, Uri

AU - Rajagopalan, Navin

AU - Modi, Kalgi

AU - Briller, Joan E.

AU - Drazner, Mark H

AU - Wells, Gretchen L.

AU - McNamara, Dennis M.

AU - Givertz, Michael M.

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N2 - Background: There is limited data on electrocardiographic (ECG) abnormalities and their prognostic significance in women with peripartum cardiomyopathy (PPCM). We sought to characterize ECG findings in PPCM and explore the association of ECG findings with myocardial recovery and clinical outcomes. Hypothesis: We hypothesized that ECG indicators of myocardial remodeling would portend worse systolic function and outcomes. Methods: Standard 12-lead ECGs were obtained at enrollment in the Investigations of Pregnancy-Associated Cardiomyopathy study and analyzed for 88 women. Left ventricular ejection fraction (LVEF) was measured by echocardiography at baseline, 6 months, and 12 months. Women were followed for clinical events (death, mechanical circulatory support, and/or cardiac transplantation) until 1 year. Results: Half of women had an “abnormal” ECG, defined as atrial abnormality, ventricular hypertrophy, ST-segment deviation, and/or bundle branch block. Women with left atrial abnormality (LAA) had lower LVEF at 6 months (44% vs 52%, P = 0.02) and 12 months (46% vs 54%, P = 0.03). LAA also predicted decreased event-free survival at 1 year (76% vs 97%, P = 0.008). Neither left ventricular hypertrophy by ECG nor T-wave abnormalities predicted outcomes. A normal ECG was associated with recovery in LVEF to ≥50% (84% vs 49%, P = 0.001) and event-free survival at 1 year (100% vs 85%, P = 0.01). Conclusions: ECG abnormalities are common in women with PPCM, but a normal ECG does not rule out the presence of PPCM. LAA predicted lower likelihood of myocardial recovery and event-free survival, and a normal ECG predicted favorable event-free survival.

AB - Background: There is limited data on electrocardiographic (ECG) abnormalities and their prognostic significance in women with peripartum cardiomyopathy (PPCM). We sought to characterize ECG findings in PPCM and explore the association of ECG findings with myocardial recovery and clinical outcomes. Hypothesis: We hypothesized that ECG indicators of myocardial remodeling would portend worse systolic function and outcomes. Methods: Standard 12-lead ECGs were obtained at enrollment in the Investigations of Pregnancy-Associated Cardiomyopathy study and analyzed for 88 women. Left ventricular ejection fraction (LVEF) was measured by echocardiography at baseline, 6 months, and 12 months. Women were followed for clinical events (death, mechanical circulatory support, and/or cardiac transplantation) until 1 year. Results: Half of women had an “abnormal” ECG, defined as atrial abnormality, ventricular hypertrophy, ST-segment deviation, and/or bundle branch block. Women with left atrial abnormality (LAA) had lower LVEF at 6 months (44% vs 52%, P = 0.02) and 12 months (46% vs 54%, P = 0.03). LAA also predicted decreased event-free survival at 1 year (76% vs 97%, P = 0.008). Neither left ventricular hypertrophy by ECG nor T-wave abnormalities predicted outcomes. A normal ECG was associated with recovery in LVEF to ≥50% (84% vs 49%, P = 0.001) and event-free survival at 1 year (100% vs 85%, P = 0.01). Conclusions: ECG abnormalities are common in women with PPCM, but a normal ECG does not rule out the presence of PPCM. LAA predicted lower likelihood of myocardial recovery and event-free survival, and a normal ECG predicted favorable event-free survival.

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KW - maternal-fetal health

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