Peripartum cardiomyopathy: analysis of clinical outcome, left ventricular function, plasma levels of cytokines and Fas/APO-1

• Published in: Journal of the American College of Cardiology Vol. 35; no. 3; pp. 701 - 705
• Main Authors: Sliwa, Karen, Skudicky, Daniel, Bergemann, Anette, Candy, Geoffrey, Puren, Adrian, Sareli, Pinhas
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-03-2000; Elsevier Science
• Subjects: Adult; Apolipoprotein A-I - blood; Biological and medical sciences; Biomarkers - blood; Cardiology. Vascular system; Cardiomyopathies - blood; Cardiomyopathies - diagnostic imaging; Cardiomyopathies - mortality; Cardiomyopathies - physiopathology; Cytokines - blood; Echocardiography; fas Receptor - blood; Female; Heart; Humans; Medical sciences; Myocarditis. Cardiomyopathies; Postpartum Period; Prognosis; Prospective Studies; Survival Rate; Ventricular Function, Left - physiology; NYHA; iNOS; PPC; ACE; FC; TNF; Human; Prognosis; Cardiomyopathy; Pathogenesis; Cytokine; Sex; Cardiovascular disease; Puerperium; Signalling; Myocardial disease; Follow up study; Heart disease; Female; Left ventricle performance; Apoptosis; Biological receptor
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(99)00624-5

OBJECTIVES
1) To evaluate the outcome of patients with peripartum cardiomyopathy (PPC) on current treatment for heart failure, 2) to assess the circulating plasma levels of cytokines and Fas receptors and 3) to identify predictors of prognosis.
BACKGROUND
Previous studies in patients with PPC were done when angiotensin-converting enzyme (ACE) inhibitors and beta-adrenergic blocking agents were not routinely used in heart failure. Inflammatory cytokines play an important role in the pathogenesis and progression of heart failure of other etiologies. However, there is a paucity of data regarding cytokine expression in patients with PPC. Plasma concentrations of Fas receptors (an apoptosis-signalling receptor) have not been reported in this population.
METHODS
We followed prospectively 29 consecutive black women with PPC. All patients were treated with diuretics, digoxin, enalapril and carvedilol. Echocardiograms were performed at baseline and after six months of treatment. Cytokine and soluble Fas/APO-1 plasma levels were measured at baseline.
RESULTS
Tumor necrosis factor-alpha, interleukin-6 and Fas/APO-1 levels were significantly elevated in the study patients compared with 20 healthy volunteers. Eight patients died. sFas/APO-1 levels were significantly higher in patients who died compared with survivors (8.98 ± 4.5 vs. 5.33 ± 3 U/ml, respectively, p = 0.02). At six months, ejection fraction improved from 26.7 ± 10 to 42.7 ± 16%, p = 0.00003, with an increment of more than 10 U in 10 patients (28.1 ± 4 to 51.9 ± 8%, p = 0.000008).
CONCLUSIONS
Cytokine and sFas levels are elevated in patients with PPC. Despite treatment with ACE inhibitors and beta-blockers, mortality remains high. However, in 34% of the patients, left ventricular function almost completely normalized.