AMH.org research....

[JAMESFETT]

AMH.org contributed to the research that led to this study report:

Int J Cardiol. 2010 Sep 20. [Epub ahead of print]

Predictors of left ventricular recovery in a cohort of peripartum cardiomyopathy patients recruited via the internet.

Safirstein JG, Ro AS, Grandhi S, Wang L, Fett JD, Staniloae C.

Department of Cardiology, The Gagnon Cardiovascular Institute at Morristown Memorial Hospital, Morristown, NJ, United States.

Abstract
BACKGROUND: Peripartum cardiomyopathy (PPCM) is the onset of acute heart failure without demonstrable cause during the last month of pregnancy or within five months after delivery. The purpose of this study was to create a prospective registry of PPCM patients with the assistance of the internet and identify clinical factors predictive of ejection fraction (EF) recovery.

METHODS: Patients with PPCM were identified by novel web-based methods. Subjects were categorized as recovered (EF>50) or nonrecovered (EF<50) and compared on the basis of demographic and clinical variables.

RESULTS: Fifty-five subjects met criteria for inclusion. There was a statistically significant association between diagnosis during third trimester and persistent systolic dysfunction (25% vs. 4.7%, p=0.03). Gestational hypertension and breastfeeding were significantly associated with EF recovery (48.8% vs. 16.7%, p=0.046, and 39.5% vs. 8.3%, p=0.04, respectively). EF normalization occurred in all patients with EF(1)≥35%.

CONCLUSIONS: Presence of gHTN, EF≥35% at diagnosis, breastfeeding, and postpartum diagnosis were all significantly associated with recovery of systolic function. Internet recruitment may be a valuable tool for studying PPCM.

PMID: 20863583 [PubMed - as supplied by publisher]

[buckeye]

Can you explain the results a little bit? Does that mean if you are breastfeeding, you have a better chance for recovery? I was advised not to breastfeed, which was very difficult for me because I breastfed my first child for the entire first year. I also didn't understand what all the numbers meant?

[JAMESFETT]

Yes, in these mothers (identified from www.amothersheart.org), there was a statistically better chance for recovery of heart function for those who did breastfeed. This is very gratifying, because for them, at least breastfeeding and higher levels of prolactin had no harmful effect; in fact they were more likely to reach those recovery levels of LVEF > 50 %. And of course none of them took bromocriptine, an inhibitor of prolactin.

Did they recover because they were breastfeeders? One can't say that. But at least the breastfeeding did not prevent their recovery. Did they recover because they started out with LVEF of 35 % or more? Maybe so, but even beyond that, those who were able to breastfeed were more likely to recover.

More work needs to be done on the prolactin and breastfeeding issue. More studies are in progress with the use of bromocriptine. Time will tell. But certainly one should not say at this point that breastfeeding is harmful. We cannot yet say for sure whether or not under some circumstances normal (and beneficial) prolactin breaks down into a harmful metabolite. We are going to find out for sure about that. Remember that not all ACE-Is can safely be used for those who are breastfeeding, but the one that contributes the least amount into breast milk is enalopril. Also, hydralazine (with or without nitrates to slow any increased heart rate resulting from hydralazine) can be substituted for ACE-I and is very effective in treatment of heart failure of PPCM. Hydralazine is safe for breastfeeding mothers and babies.

Why did those who were diagnosed in the last trimester of pregnancy, before delivery, have lower levels of recovery? I think because they may have had more severe disease, and it became manifest earlier. We need to look at that more closely.

Why were those mothers with pregnancy-induced hypertension (PIH) or gestational hypertension (gHTN)more likely to reach eventual recovery levels? I think because the hypertension cause the heart failure symptoms to be more noticeable, accounting for earlier diagnosis with LVEF at least 35 %. Hypertension is an important stressor for the heart.

So far as the numbers, whenever the "p factor" is less than or equal to 0.05, the difference is statistically significant, meaning that it happened for a reason and not because of chance alone. The percentages are the proportion of mothers who reached recovery levels of LVEF 0.50 or not. I hope that seems more clear. If not, let me know.

[buckeye]

thank you for the explanation, it is more clear now.