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

被引:168
作者
Sliwa, K
Skudicky, D
Bergemann, A
Candy, G
Puren, A
Sareli, P
机构
[1] Baragwanath Hosp, Dept Cardiol, ZA-2013 Johannesburg, South Africa
[2] Baragwanath Hosp, Dept Nucl Med, ZA-2013 Johannesburg, South Africa
[3] Univ Witwatersrand, Dept Hematol & Mol Med, Johannesburg, South Africa
关键词
D O I
10.1016/S0735-1097(99)00624-5
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 tan 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). Ar: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 id 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. (C) 2000 by the American College of Cardiology.
引用
收藏
页码:701 / 705
页数:5
相关论文
共 26 条
[1]  
BELDER A, 1995, BRIT HEART J, V74, P426
[2]   NATURAL COURSE OF PERIPARTUM CARDIOMYOPATHY [J].
DEMAKIS, JG ;
RAHIMTOOLA, SH ;
SUTTON, GC ;
MEADOWS, WR ;
SZANTO, PB ;
TOBIN, JR ;
GUNNAR, RM .
CIRCULATION, 1971, 44 (06) :1053-+
[3]   TUMOR-NECROSIS-FACTOR SOLUBLE RECEPTORS IN PATIENTS WITH VARIOUS DEGREES OF CONGESTIVE-HEART-FAILURE [J].
FERRARI, R ;
BACHETTI, T ;
CONFORTINI, R ;
OPASICH, C ;
FEBO, O ;
CORTI, A ;
CASSANI, G ;
VISIOLI, O .
CIRCULATION, 1995, 92 (06) :1479-1486
[4]   Independent and incremental prognostic value of Doppler-derived mitral deceleration time of early filling in both symptomatic and asymptomatic patients with left ventricular dysfunction [J].
Giannuzzi, P ;
Temporelli, PL ;
Bosimini, E ;
Silva, P ;
Imparato, A ;
Corra, U ;
Galli, M ;
Giordano, A .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1996, 28 (02) :383-390
[5]   Tumour necrosis factor and inducible nitric oxide synthase in dilated cardiomyopathy [J].
Habib, FM ;
Springall, DR ;
Davies, GJ ;
Oakley, CM ;
Yacoub, MH ;
Polak, JM .
LANCET, 1996, 347 (9009) :1151-1155
[6]   RECOVERY OF LEFT-VENTRICULAR FUNCTION IN PERIPARTUM CARDIOMYOPATHY [J].
HADJIMILTIADES, S ;
PANIDIS, IP ;
SEGAL, BL ;
ISKANDRIAN, AS .
AMERICAN HEART JOURNAL, 1986, 112 (05) :1097-1099
[7]   PERIPARTUM CARDIOMYOPATHY [J].
HOMANS, DC .
NEW ENGLAND JOURNAL OF MEDICINE, 1985, 312 (22) :1432-1437
[8]   SHRINKAGE NECROSIS - DISTINCT MODE OF CELLULAR DEATH [J].
KERR, JFR .
JOURNAL OF PATHOLOGY, 1971, 105 (01) :13-+
[9]   APOPTOSIS - BASIC BIOLOGICAL PHENOMENON WITH WIDE-RANGING IMPLICATIONS IN TISSUE KINETICS [J].
KERR, JFR ;
WYLLIE, AH ;
CURRIE, AR .
BRITISH JOURNAL OF CANCER, 1972, 26 (04) :239-+
[10]   PERIPARTUM CARDIOMYOPATHY [J].
LAMPERT, MB ;
LANG, RM .
AMERICAN HEART JOURNAL, 1995, 130 (04) :860-870