The Experts below are selected from a list of 327 Experts worldwide ranked by ideXlab platform
Roberto M Lang - One of the best experts on this subject based on the ideXlab platform.
-
prognostic value of echocardiography in Peripartum Cardiomyopathy
Obstetrics & Gynecology, 2005Co-Authors: Jeff B Chapa, Heather B Heiberger, Lynn Weinert, Jeanne M Decara, Roberto M Lang, Judith U HibbardAbstract:OBJECTIVE: To estimate whether echocardiography findings at the time of diagnosis of Peripartum Cardiomyopathy are predictive of persistent cardiac dysfunction. METHODS: Chart review of patients with Peripartum Cardiomyopathy between 1988 and 2001 was performed. Data from echocardiography, including fractional shortening and left ventricular end diastolic dimension, were recorded both at the time of diagnosis and at follow-up. Left ventricular dysfunction was defined by echocardiography as fractional shortening less than 30% and left ventricular end diastolic dimension of 4.8 cm or more. RESULTS: Of 32 patients meeting our definition for Peripartum Cardiomyopathy and for whom follow-up data were available, 13 (41%) had recovery of ventricular function, while 19 (59%) continued to have persistent left ventricular dysfunction. Those who did not recover cardiac function had a higher left ventricular end diastolic dimension and a lower fractional shortening at diagnosis than those who recovered. A fractional shortening value less than 20% and a left ventricular end diastolic dimension 6 cm or greater at the time of diagnosis was associated with a more than 3-fold higher risk for persistent left ventricular dysfunction. CONCLUSION: Along with being an important diagnostic tool in Peripartum Cardiomyopathy, echocardiography may provide significant prognostic information with regards to recovery of cardiac function.
-
contractile reserve in patients with Peripartum Cardiomyopathy and recovered left ventricular function
American Journal of Obstetrics and Gynecology, 1997Co-Authors: Mark B Lampert, Lynn Weinert, Judy Hibbard, Claudia E Korcarz, Marshall D Lindheimer, Roberto M LangAbstract:Abstract OBJECTIVES: Peripartum Cardiomyopathy is a rare complication of pregnancy. Thirty percent of patients with this disorder are reported to recover baseline ventricular function within 6 months of delivery, but the ability of these ventricles to respond to hemodynamic stress is unknown. The aim of this investigation was to quantitatively assess the contractile reserve of patients with a history of Peripartum Cardiomyopathy and recovered left ventricular function. STUDY DESIGN: Baseline left ventricular contractility was assessed by use of the load and heart rate–independent relationship between end-systolic stress and rate-corrected velocity of fiber shortening. Data were acquired from "recovered" patients (10.5 ± 11.6 months after delivery) and compared with data from matched nonpregnant controls with use of two-dimensionally targeted M-mode echocardiography and calibrated subclavian pulse tracings that were recorded over a wide range of afterloads (end-systolic stress) generated by methoxamine (1 mg/min) infusion. Contractile reserve was assessed by a dobutamine challenge (5 μg/kg/min) and quantified as the vertical deviation of the dobutamine end-systolic stress minus the corrected velocity of fiber shortening data point from the baseline contractility line. RESULTS: Patients with Peripartum Cardiomyopathy and matched controls had normal baseline heart rates, blood pressures, ventricular dimensions, and left ventricular function. Contractile reserve, however, was reduced in patients with recovered Peripartum Cardiomyopathy (0.30 ± 0.12 vs 0.17 ± 0.04 circ/sec, p CONCLUSIONS: Women with a history of Peripartum Cardiomyopathy who have regained normal resting left ventricular size and performance have decreased contractile reserve revealed by the use of a dobutamine challenge test. Ventricles of these women may respond suboptimally to hemodynamic stress in spite of evidence of recovery by routine echocardiographic evaluation. (Am J Obstet Gynecol 1997;176:189-95.)
Lynn Weinert - One of the best experts on this subject based on the ideXlab platform.
-
prognostic value of echocardiography in Peripartum Cardiomyopathy
Obstetrics & Gynecology, 2005Co-Authors: Jeff B Chapa, Heather B Heiberger, Lynn Weinert, Jeanne M Decara, Roberto M Lang, Judith U HibbardAbstract:OBJECTIVE: To estimate whether echocardiography findings at the time of diagnosis of Peripartum Cardiomyopathy are predictive of persistent cardiac dysfunction. METHODS: Chart review of patients with Peripartum Cardiomyopathy between 1988 and 2001 was performed. Data from echocardiography, including fractional shortening and left ventricular end diastolic dimension, were recorded both at the time of diagnosis and at follow-up. Left ventricular dysfunction was defined by echocardiography as fractional shortening less than 30% and left ventricular end diastolic dimension of 4.8 cm or more. RESULTS: Of 32 patients meeting our definition for Peripartum Cardiomyopathy and for whom follow-up data were available, 13 (41%) had recovery of ventricular function, while 19 (59%) continued to have persistent left ventricular dysfunction. Those who did not recover cardiac function had a higher left ventricular end diastolic dimension and a lower fractional shortening at diagnosis than those who recovered. A fractional shortening value less than 20% and a left ventricular end diastolic dimension 6 cm or greater at the time of diagnosis was associated with a more than 3-fold higher risk for persistent left ventricular dysfunction. CONCLUSION: Along with being an important diagnostic tool in Peripartum Cardiomyopathy, echocardiography may provide significant prognostic information with regards to recovery of cardiac function.
-
contractile reserve in patients with Peripartum Cardiomyopathy and recovered left ventricular function
American Journal of Obstetrics and Gynecology, 1997Co-Authors: Mark B Lampert, Lynn Weinert, Judy Hibbard, Claudia E Korcarz, Marshall D Lindheimer, Roberto M LangAbstract:Abstract OBJECTIVES: Peripartum Cardiomyopathy is a rare complication of pregnancy. Thirty percent of patients with this disorder are reported to recover baseline ventricular function within 6 months of delivery, but the ability of these ventricles to respond to hemodynamic stress is unknown. The aim of this investigation was to quantitatively assess the contractile reserve of patients with a history of Peripartum Cardiomyopathy and recovered left ventricular function. STUDY DESIGN: Baseline left ventricular contractility was assessed by use of the load and heart rate–independent relationship between end-systolic stress and rate-corrected velocity of fiber shortening. Data were acquired from "recovered" patients (10.5 ± 11.6 months after delivery) and compared with data from matched nonpregnant controls with use of two-dimensionally targeted M-mode echocardiography and calibrated subclavian pulse tracings that were recorded over a wide range of afterloads (end-systolic stress) generated by methoxamine (1 mg/min) infusion. Contractile reserve was assessed by a dobutamine challenge (5 μg/kg/min) and quantified as the vertical deviation of the dobutamine end-systolic stress minus the corrected velocity of fiber shortening data point from the baseline contractility line. RESULTS: Patients with Peripartum Cardiomyopathy and matched controls had normal baseline heart rates, blood pressures, ventricular dimensions, and left ventricular function. Contractile reserve, however, was reduced in patients with recovered Peripartum Cardiomyopathy (0.30 ± 0.12 vs 0.17 ± 0.04 circ/sec, p CONCLUSIONS: Women with a history of Peripartum Cardiomyopathy who have regained normal resting left ventricular size and performance have decreased contractile reserve revealed by the use of a dobutamine challenge test. Ventricles of these women may respond suboptimally to hemodynamic stress in spite of evidence of recovery by routine echocardiographic evaluation. (Am J Obstet Gynecol 1997;176:189-95.)
Mark B Lampert - One of the best experts on this subject based on the ideXlab platform.
-
contractile reserve in patients with Peripartum Cardiomyopathy and recovered left ventricular function
American Journal of Obstetrics and Gynecology, 1997Co-Authors: Mark B Lampert, Lynn Weinert, Judy Hibbard, Claudia E Korcarz, Marshall D Lindheimer, Roberto M LangAbstract:Abstract OBJECTIVES: Peripartum Cardiomyopathy is a rare complication of pregnancy. Thirty percent of patients with this disorder are reported to recover baseline ventricular function within 6 months of delivery, but the ability of these ventricles to respond to hemodynamic stress is unknown. The aim of this investigation was to quantitatively assess the contractile reserve of patients with a history of Peripartum Cardiomyopathy and recovered left ventricular function. STUDY DESIGN: Baseline left ventricular contractility was assessed by use of the load and heart rate–independent relationship between end-systolic stress and rate-corrected velocity of fiber shortening. Data were acquired from "recovered" patients (10.5 ± 11.6 months after delivery) and compared with data from matched nonpregnant controls with use of two-dimensionally targeted M-mode echocardiography and calibrated subclavian pulse tracings that were recorded over a wide range of afterloads (end-systolic stress) generated by methoxamine (1 mg/min) infusion. Contractile reserve was assessed by a dobutamine challenge (5 μg/kg/min) and quantified as the vertical deviation of the dobutamine end-systolic stress minus the corrected velocity of fiber shortening data point from the baseline contractility line. RESULTS: Patients with Peripartum Cardiomyopathy and matched controls had normal baseline heart rates, blood pressures, ventricular dimensions, and left ventricular function. Contractile reserve, however, was reduced in patients with recovered Peripartum Cardiomyopathy (0.30 ± 0.12 vs 0.17 ± 0.04 circ/sec, p CONCLUSIONS: Women with a history of Peripartum Cardiomyopathy who have regained normal resting left ventricular size and performance have decreased contractile reserve revealed by the use of a dobutamine challenge test. Ventricles of these women may respond suboptimally to hemodynamic stress in spite of evidence of recovery by routine echocardiographic evaluation. (Am J Obstet Gynecol 1997;176:189-95.)
Lori A. Blauwet - One of the best experts on this subject based on the ideXlab platform.
-
Subsequent Pregnancy Outcomes in Patients With Peripartum Cardiomyopathy.
Obstetrics & Gynecology, 2020Co-Authors: Elisabeth Codsi, Carl H. Rose, Lori A. BlauwetAbstract:OBJECTIVE:To describe cardiac and obstetric outcomes in subsequent pregnancies of patients with Peripartum Cardiomyopathy and to report demographic and clinical characteristics of index pregnancies. METHODS:We conducted a retrospective cohort study of all pregnant patients with prior Peripartum Cardiomyopathy seen at the Mayo Clinic from January 2000 through March 2017. Maternal and neonatal outcome data of index and all subsequent pregnancies were abstracted, and all echocardiography examinations were individually reviewed. RESULTS:Twenty-five patients with prior Peripartum Cardiomyopathy were included; all except one had recovered left ventricular (LV) function (LV ejection fraction 50% or greater) before the subsequent pregnancy. Forty-three subsequent pregnancies were identified: six (14.0%) miscarriages, four (9.3%) terminations, and 33 (76.7%) live births. The rate of Peripartum Cardiomyopathy relapse was 20.9%; median LV ejection fraction nadir in patients with relapse was 43% (range 35-45%). None had LV ejection fraction decline to the level of their index pregnancy. No cardiac arrests or deaths were observed, and all patients with relapse recovered LV function. Median gestational age at delivery for all live births in subsequent pregnancies was 39.0 weeks (range 36 6/7-41 3/7 weeks). CONCLUSION:Patients with a history of Peripartum Cardiomyopathy who recover LV function are at risk for a transient minor decrease in LV ejection fraction during future pregnancies, but obstetric and neonatal outcomes are often favorable.
-
diagnosis and management of Peripartum Cardiomyopathy
Heart, 2011Co-Authors: Lori A. Blauwet, Leslie T CooperAbstract:Peripartum Cardiomyopathy (PPCM) is a relatively rare idiopathic form of heart failure that affects women during the last months of pregnancy or the first months after delivery. The aetiology and pathophysiological mechanisms of this disease are poorly characterised and incompletely understood. Diagnosis remains a challenge, as PPCM symptoms vary and may mimic those commonly experienced by women during pregnancy and postpartum due to normal physiological changes that occur during this period. The clinical course varies between complete recovery to rapid progression to end stage heart failure and even death. Standard heart failure treatment, with adjustments for women who are pregnant or lactating, is the treatment of choice. Disease specific therapeutic strategies, including prolactin blockade, show promise. National and international registries and collaborative research efforts are warranted to characterise this disease better and to develop novel treatments that can improve outcomes. Heart failure during pregnancy has been recognised since the mid 19th century, but it was not until 1971 that Demakis and colleagues proposed diagnostic criteria for PPCM.w1 These diagnostic criteria have subsequently been revised by several groups1 2 w2 (table 1). View this table: Table 1 Definition of Peripartum Cardiomyopathy The common elements in all of the proposed criteria are that PPCM is a relatively rare idiopathic form of heart failure with left ventricular (LV) systolic dysfunction that occurs during the Peripartum period. The true incidence of PPCM is unknown, as clinical presentation varies and no systematic epidemiological studies have been conducted. Current estimates, ranging between 18 per 100 000 and 333 per 100 000 births, are primarily based on case series from single centres (figure 1). Figure 1 The reported incidence of Peripartum Cardiomyopathy (PPCM) in the USA varies considerably, while the reported incidences in several African and Asian countries are similar. Alfred …
Andrea G. Witlin - One of the best experts on this subject based on the ideXlab platform.
-
Peripartum Cardiomyopathy: A longitudinal echocardiographic study
American Journal of Obstetrics and Gynecology, 1997Co-Authors: Andrea G. Witlin, William C. Mabie, Baha M. SibaiAbstract:Abstract Objective: Our purpose was to determine echocardiographic trends after initial diagnosis of Peripartum Cardiomyopathy. Study Design: Nine women diagnosed with Peripartum Cardiomyopathy were prospectively recruited for a longitudinal echocardiographic study. Severe myocardial dysfunction was defined as left ventricular end-diastolic dimension ≥60 mm + fractional shortening ≤21%, and mild dysfunction was defined as left ventricular end-diastolic dimension
-
Peripartum Cardiomyopathy: an ominous diagnosis.
American journal of obstetrics and gynecology, 1997Co-Authors: Andrea G. Witlin, William C. Mabie, Baha M. SibaiAbstract:Our purpose was to review and characterize the initial presentation, etiology, and prognosis of Peripartum Cardiomyopathy. Cases of Peripartum Cardiomyopathy confirmed by echocardiography were prospectively collected between 1986 and 1994. A total of 28 patients without an antecedent history of heart disease were diagnosed with Peripartum Cardiomyopathy. Common associated disorders included preeclampsia or chronic hypertension (19), alcohol abuse (2), family history (2), and multiple tocolytic therapy (2). Five deaths occurred (18% mortality), 3 patients received heart transplants (11%), 18 continued with cardiac impairment (64%), and only 2 patients (7%) had regress on of Cardiomyopathy. The perinatal mortality rate was 36 per 1000 births. Six patients had seven subsequent pregnancies; 4 patients decompensated earlier in the subsequent pregnancy, 1 patient remained well compensated on medical therapy in spite of poor systolic function and a dilated left ventricle, and 1 patient had two subsequent pregnancies without recurrence of cardiac compromise. The unique hemodynamic stresses of pregnancy unmask previously undiagnosed Cardiomyopathy in otherwise medically stable individuals. The prognosis for these patients is guarded.
-
Peripartum Cardiomyopathy an ominous diagnosis
American Journal of Obstetrics and Gynecology, 1997Co-Authors: Andrea G. Witlin, William C. Mabie, Bahaeddine M SibaiAbstract:Abstract OBJECTIVE: Our purpose was to review and characterize the initial presentation, etiology, and prognosis of Peripartum Cardiomyopathy. STUDY DESIGN: Cases of Peripartum Cardiomyopathy confirmed by echocardiography were prospectively collected between 1986 and 1994. RESULTS: A total of 28 patients without an antecedent history of heart disease were diagnosed with Peripartum Cardiomyopathy. Common associated disorders included preeclampsia or chronic hypertension (19), alcohol abuse (2), family history (2), and multiple tocolytic therapy (2). Five deaths occurred (18% mortality), 3 patients received heart transplants (11%), 18 continued with cardiac impairment (64%), and only 2 patients (7%) had regression of Cardiomyopathy. The perinatal mortality rate was 36 per 1000 births. Six patients had seven subsequent pregnancies; 4 patients decompensated earlier in the subsequent pregnancy, 1 patient remained well compensated on medical therapy in spite of poor systolic function and a dilated left ventricle, and 1 patient had two subsequent pregnancies without recurrence of cardiac compromise. CONCLUSION: The unique hemodynamic stresses of pregnancy unmask previously undiagnosed Cardiomyopathy in otherwise medically stable individuals. The prognosis for these patients is guarded. (Am J Obstet Gynecol 1997;176:182-8.)