Maternal Obesity Affects Cardiac Remodeling and Recovery in Women with Peripartum Cardiomyopathy

Esa M. Davis; Gregory Ewald; Michael M. Givertz; Navin Rajagopalan; Leslie T. Cooper Jr; Joan Briller; G. Michael Felker; Biykem Bozkurt; Mark H. Drazner; Karen Hanley-Yanez; Indrani Halder; Charles F. McTiernan; Dennis M. McNamara; on behalf of the IPAC Investigators

doi:10.1055/s-0038-1669439

American Journal of Perinatology, Table of Contents

Am J Perinatol 2019; 36(05): 476-483
DOI: 10.1055/s-0038-1669439

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Maternal Obesity Affects Cardiac Remodeling and Recovery in Women with Peripartum Cardiomyopathy

Authors

Esa M. Davis

¹Department of Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Gregory Ewald

²Department of Medicine, Washington University, St. Louis, Missouri
Michael M. Givertz

³Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
Navin Rajagopalan

⁴Department of Medicine, University of Kentucky, Lexington, Kentucky
Leslie T. Cooper Jr

⁵Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
Joan Briller

⁶Department of Medicine, University of Illinois at Chicago, Illinois
G. Michael Felker

⁷Department of Medicine, Duke University, Durham, North Carolina
Biykem Bozkurt

⁸Department of Medicine, Baylor College of Medicine, Houston, Texas
Mark H. Drazner

⁹Department of Medicine, UT Southwestern Medical Center, Dallas, Texas
Karen Hanley-Yanez

¹⁰Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
Indrani Halder

¹⁰Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
Charles F. McTiernan

¹⁰Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
Dennis M. McNamara

¹⁰Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania

on behalf of the IPAC Investigators

Abstract

Objective To examine the association between maternal obesity on left ventricular (LV) size and recovery in women with peripartum cardiomyopathy (PPCM).

Study Design This was a prospective analysis of 100 women enrolled within 13 weeks of PPCM diagnosis and followed for a year in the Investigation of Pregnancy Associated Cardiomyopathy study. Adiposity was defined by standard body mass index (BMI) definitions for under/normal weight, overweight, and obesity. Demographic, clinical, and biomarker variables were compared across weight categories.

Outcomes LV end-diastolic diameter (LVEDD) and ejection fraction were measured at entry, 6, and 12 months postpartum. Multivariable regression models examined the relationship between adiposity, LV size, and leptin levels with cardiac recovery at 6 and 12 months postpartum.

Results Obese and nonobese women had similar LV dysfunction at entry. Obese women had greater LV size and less LV recovery at 6 and 12 months postpartum. BMI was positively associated with leptin and ventricular diameter. Greater BMI at entry remained associated with less ventricular recovery at 6 months (p = 0.02) in adjusted race-stratified models. LVEDD at entry predicted lower ejection fraction at 6 months (p < 0.001) and similarly at 12 months.

Conclusion Obese women with PPCM had greater cardiac remodeling, higher leptin levels, and diminished cardiac recovery.

Keywords

peripartum cardiomyopathy - obesity - pregnancy - nonischemic cardiomyopathy - maternal leptin - left ventricular ejection fraction - left ventricular end-diastolic diameter

Full Text

References

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