Left Ventricular Function After a New Pregnancy in Patients With Peripartum Cardiomyopathy JOSE ´ LEA ˜ O DE SOUZA, Jr, MD, CLOVIS DE CARVALHO FRIMM, MD, PhD, LUCIANO NASTARI, MD, CHARLES MADY, MD, PhD Sa ˜o Paulo, Brazil ABSTRACT Background: A new pregnancy is usually discouraged in patients with peripartum cardio- myopathy (PPCM), particularly when there is persistent left ventricular dysfunction. This study was undertaken to evaluate left ventricular systolic function after a new pregnancy in patients with PPCM. Methods and Results: Nine of 44 patients with PPCM became pregnant and were selected for this study. Two patients were lost to follow-up, 1 immediately after the new pregnancy diagnosis, and the other 1 after the latest delivery, and, thus, were excluded. The remaining 7 patients had regular clinical and obstetric examinations until delivery, continued follow-up, and were submitted to echocardiography 6 to 12 months thereafter. Pregnancy was relatively well tolerated in the patients, and they gave birth to 7 healthy newborns. After this latest pregnancy, 4 patients with heart failure functional class II and 2 patients with functional class III remained unchanged. A patient, initially in functional class III, improved and was then in functional class II. Although left ventricular end-diastolic diameter did not change (61 to 58 mm), left ventricular end-systolic dimension decreased (50 to 47 mm, P = .008), resulting in a significant increase in left ventricular fractional shortening (19% to 23%, P = .02). Conclusion: Although based only in a small number of patients, the present results suggest that cardiac function does not deteriorate during a new pregnancy in patients with PPCM. Key words: peripartum cardiomyopathy, echocardiography, left ventricular function, pregnancy. Peripartum cardiomyopathy (PPCM) is characterized as a cause of heart failure developing in previously healthy women during the third trimester of pregnancy or up to the sixth month of puerperium (1–3). It is a rela- tively rare disease, with an estimated incidence ranging from 1:100 to 1:15,000 cases per pregnancy (4). In general, black women over 30 years of age, with multiple or twin pregnancies, and with eclampsy, are those most commonly affected (4,5). Mortality rates are reported to be disappointingly high, reaching up to 50% of patients during the first 3 months of puerperium (3,4,6). PPCM has been related to the progression of heart failure and to thromboembolic complications as well. However, a bet- ter long-term outcome has been recently reported com- pared with different types of dilated cardiomyopathy (7). Left ventricular end-diastolic internal dimension greater than 70 mm and left ventricular fractional short- ening of 15% or less have been recognized as contribu- tors to a poor prognosis (8 –10). The impairment of contractile reserve has been reported to persist through the complete resolution of cardiac dysfunction (11). The potential harmful effects of a new pregnancy on left ventricular systolic function are still undetermined. Also, From the Heart Institute (InCor), University of Sa ˜o Paulo Medical School, Sa ˜o Paulo, Brazil. Manuscript received June 23, 2000; revised manuscript received October 16, 2000; revised manuscript accepted December 12, 2000. Reprint requests: Jose ´ Lea ˜o de Souza Jr, MD, Heart Institute, Uni- versity of Sa ˜o Paulo Medical School, Av. Dr. Eneas C. Aguiar, 44, 05403-900-Sa ˜o Paulo-SP, Brazil. Copyright © 2001 by Churchill Livingstone 1071-9164/01/0701-0005$35.00/0 doi:10.1054/jcaf.2001.22424 Journal of Cardiac Failure Vol. 7 No. 1 2001 30