Risk factors for maternal outcome in pregnancy complicated with dilated cardiomyopathy

Dilated cardiomyopathy (DCM) is characterized by ventricular enlargement and systolic cardiac dysfunction, especially on the left side. In association with pregnancy, there are two types of DCM: peripartum cardiomyopathy (PPCM) and DCM not categorized as PPCM. PPCM is distinguishable from DCM-complicated pregnancy by the time of onset, as PPCM is defined as occurring in the last month of pregnancy until 5 months after delivery and by the causal relationship, with PPCM exclusively associated with cardiac lesions such as valve or coronary disease. Elkayam et al. defined ‘pregnancy-associated (PA) cardiomyopathy’ as a condition that occurred during pregnancy except in the last month and reported similar clinical characteristics to those of PPCM. Morales et al. found common genetic mutations in PPCM and DCM. At present, however, PPCM and DCM-complicated pregnancy are considered to be different disorders. There have been many studies of the etiology, epidemiology, prognosis and treatment of PPCM, but only a few studies of DCM-complicated pregnancy. Bernstein and Magriples compared the cardiac outcomes of DCM-complicated pregnancy with PPCM and Grewal et al. compared similar outcomes in cases of DCM, with and without pregnancy. DCM-complicated pregnancy showed a better prognosis than PPCM, but a worse prognosis than non-pregnant DCM. These results indicate a negative impact of pregnancy on the cardiac outcome of DCM. Therefore, the current retrospective study of DCM-complicated pregnancy was carried out to determine parameters that are significantly associated with cardiac outcome at 1 year after delivery, to examine whether early termination of pregnancy preserves cardiac function and to establish whether the outcome of PA DCM is worse than that of pre-pregnancy DCM.