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Koerber D, Khan S, Kirubarajan A, Spivak A, Wine R, Matelski J, Sobel M, Harris K. Meta-Analysis of Long-Term (>1 Year) Cardiac Outcomes of Peripartum Cardiomyopathy. Am J Cardiol 2023; 194:71-77. [PMID: 36989549 DOI: 10.1016/j.amjcard.2023.01.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/19/2022] [Accepted: 01/23/2023] [Indexed: 03/31/2023]
Abstract
Peripartum cardiomyopathy is the development of heart failure toward the end of pregnancy or in the months after delivery in the absence of other attributable causes, with left ventricular systolic dysfunction and a left ventricular ejection fraction (LVEF) generally <45%. Given that patients are relatively young at the time of diagnosis, this study was performed to summarize current evidence surrounding the long-term cardiac outcomes. MEDLINE, Embase, Cochrane CENTRAL, and CINAHL were searched for original studies that reported long-term (>1 year) patient outcomes. Of the 3,144 total records identified, 62 studies involving 4,282 patients met the selection criteria. The mean LVEF was 28% at diagnosis and 47% at the time of the last follow-up. Approximately half of the patients achieved myocardial recovery (47%), most commonly defined as an LVEF >50% (n = 21). The prevalence of implantable cardioverter-defibrillator use, left ventricular assist device implantation, and heart transplantation was 12%, 7%, and 11%, respectively. The overall all-cause mortality was 9%, and despite having more cardiovascular risk factors, patients residing in high-income countries had superior outcomes, including reduced rates of mortality.
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Affiliation(s)
- Daniel Koerber
- Faculty of Medicine, University of Alberta, Edmonton, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shawn Khan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Abirami Kirubarajan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alexandra Spivak
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Wine
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Mara Sobel
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kristin Harris
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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Baisan RA, Turcu CA, Condurachi EI, Vulpe V. Retrospective evaluation of notched and fragmented QRS complex in dogs with naturally occurring myxomatous mitral valve disease. Vet Q 2021; 41:301-307. [PMID: 34643161 PMCID: PMC8547883 DOI: 10.1080/01652176.2021.1992803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Myxomatous mitral valve disease (MMVD) is the most common cardiac disease in dogs. The association of QRS notching (nQRS) or fragmentation (fQRS) with disease severity is currently unknown. The study objective was to assess the prevalence of nQRS and fQRS in dogs with MMVD and its severity according to ACVIM classification and to compare the results with a group of healthy dogs. This retrospective cross-sectional study included 34 healthy control dogs and 155 dogs with spontaneous MMVD (42% of dogs in class B1, 23% in class B2 and 35% in class C). fQRS was defined as nQRS complexes in two contiguous leads in the frontal plane (leads I and aVL) and (II, III or aVF). A one-way ANOVA with Bonferroni post-hoc test was used to assess the differences in continuous data between control and MMVD groups. Of the MMVD group, 58% showed nQRS in at least one lead and 27% presented fQRS. There was no difference between the number of leads with a nQRS and disease severity (p = 0.75) nor did the number of leads with a nQRS correlate with left atrial size (r = 0.48; p = 0.5). The number of dogs with fQRS did not differ among classes of MMVD (p = 0.21). nQRS and fQRS were more prevalent in dogs with MMVD compared to control dogs (p < 0.01). This study did not identify any relationship between the number of leads with a nQRS and disease severity. However, dogs with MMVD had a higher prevalence of nQRS and fQRS compared to control group.
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Affiliation(s)
- Radu Andrei Baisan
- Clinics Department, Faculty of Veterinary Medicine, University of Applied Life Sciences "Ion Ionescu de la Brad", Iași, Romania
| | - Cătălina Andreea Turcu
- Clinics Department, Faculty of Veterinary Medicine, University of Applied Life Sciences "Ion Ionescu de la Brad", Iași, Romania
| | - Eusebiu Ionuț Condurachi
- Clinics Department, Faculty of Veterinary Medicine, University of Applied Life Sciences "Ion Ionescu de la Brad", Iași, Romania
| | - Vasile Vulpe
- Clinics Department, Faculty of Veterinary Medicine, University of Applied Life Sciences "Ion Ionescu de la Brad", Iași, Romania
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Tekin Tak B, Cay S, Ekizler FA, Ozcan Cetin EH, Pamukcu HE, Kafes H, Ulvan N, Ozeke O, Ozcan F, Topaloglu S, Aras D. Fragmented QRS as a candidate marker for left ventricular nonrecovery in patients with peripartum cardiomyopathy. Ann Noninvasive Electrocardiol 2019; 25:e12708. [PMID: 31587432 PMCID: PMC7358786 DOI: 10.1111/anec.12708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/14/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Fragmented QRS (fQRS) complex, with various morphology, has been recently described as a diagnostic criterion of several cardiac diseases. However, there are little data regarding the prognostic role of fQRS in peripartum cardiomyopathy (PPCM) patients. We aimed to investigate the effect of fQRS on predicting left ventricular (LV) nonrecovery in patients with peripartum cardiomyopathy (PPCM). METHODS Ninety patients (mean age: 34.7 ± 6.5 years) with the diagnosis of PPCM were analyzed retrospectively. The median follow-up period of was 67.0 (12.0-192.0) months. Fragmented QRS was defined as the presence of various RSR' patterns (QRS duration < 120 ms) with or without Q wave, which include an additional R wave (R' prime) or notching of the R wave or S wave, or the presence of more than one R' (fragmentation) without typical bundle branch block. Recovery of LV function was defined as the presence of LV ejection fraction (EF) >45%. RESULTS Of the patients, 54 (60%) did not recover LV function at the last follow-up visit (nonrecovery group), while 36 of the patients (40%) exhibited LV recovery (recovery group). LV ejection fraction (EF) and fQRS were identified as independent predictors of LV nonrecovery in patients with PPCM (odds ratio OR: 5.546, 95% confidence interval CI: 0.792-0.979, p = .019 and OR: 5.986, 95% CI: 1.313-11.787, p = .014, respectively). CONCLUSION Our data firstly indicated that presence of fQRS was a significant predictor of LV nonrecovery in patients with PPCM. The fQRS might assist in identifying high-risk patients.
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Affiliation(s)
- Bahar Tekin Tak
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Firdevs Aysenur Ekizler
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Elif Hande Ozcan Cetin
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Hilal Erken Pamukcu
- Department of Cardiology, Dışkapı Education and Research Hospital, Health Sciences University Ankara, Turkey
| | - Habibe Kafes
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Nedret Ulvan
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Firat Ozcan
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Dursun Aras
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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