Lowest Risk Relapse

[Erin]

I live near UMKC Med Center, and there are medical students everywhere here it seems. I was recently told by one that women in the lowest risk category for relapse of PPCM with subsequent pregnancy not only includes having EF greater than 50% and normal contractile reserve but also having recovered normal EF in six months or less following diagnosis. Is this true?

Thanks, Dr. Fett.

[JAMESFETT]

Unfortunately, that only perpetuates the myth that has developed, and there is substantial evidence that it is simply not true. Of course one always hopes for a faster recovery, and the prognosis of those persons is very good.

That is the very subject for my American Heart Association abstract that I will present at the Annual Scientific Meeting in New Orleans on 9 November 2008. I will share that information with you when I am free to do so after presentation.

So far, the most important features that are associated with lower risk of relapse of heart failure in a subsequent pregnancy are:
1)Recovery of LV EF > 50 % post-diagnosis, no matter when that happens, and
2)Adequate contractile reserve on exercise stress echo.

JD

[MissaBaby]

Dr Fett
I don't remember being told when I had a stress echo what my contractile reserve was, nor do I recall seeing it on the summary page. Does it go by another name on my echo study? What should I be looking for?

thanks!

[JAMESFETT]

Look for "exercise stress echo." That requires an echo at rest, and then exercise on a treadmill or exercise bike, followed by another echo when exercise target heart rate is reached. The difference gained from resting to exercise LV EF represents the contractile reserve. We would like to see at least a 10 point gain as showing adequate reserve. The exercise stress echo is replacing the dobutamine stress echo, which involves IV injection of dobutamine, and therefore has a greater risk of reactions.

JD