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J Am Coll Cardiol, 1999; 34:177-180
© 1999 by the American College of Cardiology Foundation
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CLINICAL STUDIES

Intravenous immune globulin in the therapy of peripartum cardiomyopathy

Biykem Bozkurt, MD*, Flordeliza S. Villaneuva, MD, FACC{dagger}, Richard Holubkov, PhD{dagger} {ddagger}, Tammy Tokarczyk, RN, BSN{dagger}, René J. Alvarez, Jr., MD{dagger}, Guy A. MacGowan, MB, BCh{dagger}, Srinivas Murali, MD, FACC{dagger}, Warren D. Rosenblum, MD{dagger}, Arthur M. Feldman, MD, PhD, FACC{dagger} and Dennis M. McNamara, MD, FACC{dagger}

* Section of Cardiology, Baylor College of Medicine, VA Medical Center, Houston, Texas, USA
{dagger} Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
{ddagger} Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Manuscript received July 23, 1998; revised manuscript received February 11, 1999, accepted March 15, 1999.

Reprint requests and correspondence: Dr. Dennis M. McNamara, University of Pittsburgh Medical Center, Division of Cardiology, 200 Lothrop St., S558 Scaife Hall, Pittsburgh, Pennsylvania 15213
mcnamaradm{at}msx.upmc.edu

OBJECTIVES

We sought to evaluate the effect of therapy with intravenous immune globulin on recovery of left ventricular function in women presenting with peripartum cardiomyopathy.

BACKGROUND

Peripartum cardiomyopathy is a rare complication of pregnancy that results in significant morbidity and mortality in women of childbearing age. Intravenous immune globulin has been reported to improve left ventricular systolic function in patients with acute dilated cardiomyopathy and myocarditis, but its effectiveness in peripartum cardiomyopathy is unknown.

METHODS

In this retrospective study, we compared the clinical outcomes of six women with peripartum cardiomyopathy treated with intravenous immune globulin (2 g/kg) with those of 11 recent historical control subjects. All women in the study were referred between 1991 and 1998 with class II to IV heart failure and a left ventricular ejection fraction of <0.40. Left ventricular ejection was reassessed during early follow-up (6.1 ± 2.9 months).

RESULTS

The two groups did not differ in terms of baseline left ventricular ejection fraction, left ventricular end-diastolic diameter, months to presentation, age or multiparity. The improvement in left ventricular ejection fraction in patients treated with immune globulin was significantly greater than in the conventionally treated group (increase of 26 ± 8 ejection fraction units vs. 13 ±13, p = 0.042).

CONCLUSIONS

In this small retrospective study of women with peripartum cardiomyopathy, patients treated with immune globulin had a greater improvement in ejection fraction during early follow-up than patients treated conventionally. Given the poor prognosis of women with peripartum cardiomyopathy who do not improve, this therapy merits further study.

Abbreviations and Acronyms
  EF = ejection fraction
  LVEF = left ventricular ejection fraction




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