Comparison and analysis of different diagnostic criteria for peripartum cardiomyopathy / 中华妇产科杂志

ABSTRACT

Objective To compare the differences and similarities between the diagnostic criteria of obstetrics and internal medicine in China with that of Hibbard for peripartum cardiomyopathy (PPCM).Methods From March 1995 to September 2009, a total of 49 patients were diagnosed as PPCM at the Peking University People's Hospital and the Fu Wai Hospital in Beijing, China. Obstetric diagnostic criteria wasPPCM was one of dilated cardiomyopathy,occurred during the third trimester of pregnancy through the 6th month postpartum,and without cardiovascular diseases before. Internal medicine diagnostic criteria wasPPCM was unexplained cardiomegaly and heart failure, occurred during the last month of pregnancy through the 5th month postpartum, and meet the echocardiographic criteria of dialated cardiomyopathy as followsleft ventricular end-diastolic dimension (LVEDd) greater than 5.0 cm; left ventricular ejection fraction (LVEF)less than 45% , and(or) left ventricular fractional shortening (LVFS) less than 30% ; or LVEDd greater than 2. 7 cm/body surface area (m2) ; or LVEDd > 117% of age and body surface area predictive value. Hibbard diagnostic criteria was All four of the following (1) heart failure within last month of pregnancy and 5 months postpartum; (2) absence of prior heart disease; (3) no determinable cause; (4) strict echocardiographic indication of left ventricular dysfunction; LVEF less than 45% , and/or LVFS less than 30% , and LVEDd greater than 2. 7 cm/m2. The compliance between obstetric and internal criteria with Hibbard criteria, and the reasons of incompliance between Chinese and international criteria were analyzed. Results Eight patients were diagnosed of PPCM by obstetricians according to Chinese obstetric criteria. Among them, 6 patients (6/8) did not meet Hibbard criteria. 2 of the six did not reach the time regulated in the criteria. All of the six had other determinable causes for heart failure, and their echocardiographic results did not meet the diagnostic standard either. The other 41 patients were diagnosed of PPCM by physicians according to Chinese internal medicine criteria. Among them, 7 patients (17%) did not meet Hibbard criteria, 3 of the seven did not reach the time regulated in the criteria, and had other determinable causes for heart failure either. 4 of the seven did not meet the echocardiographic standard part in the criteria. The Chinese internal medicine diagnostic criteria has a significant higher coincidence rate with Hibbard criteria, compared to Chinese obstetric criteria (83% vs. 25% ; P <0. 01). Among all 13 patients whose PPCM diagnosis did not meet Hibbard criteria, 5 cases did not reach the time regulated in the criteria, 9 cases had other determinable causes for heart failure, and 10 cases did not meet the echocardiographic standard part in the criteria. Preeclampsia was the most common determinable causes for heart failure, accounted for 7 cases. Conclusion There is obvious difference between Chinese and Hibbard diagnostic criteria for PPCM, especially Chinese obstetric criteria.