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Impact of autoantibodies against the M2-muscarinic acetylcholine receptor on clinical outcomes in peripartum cardiomyopathy patients with standard treatment.
- Source :
-
BMC cardiovascular disorders [BMC Cardiovasc Disord] 2021 Dec 28; Vol. 21 (1), pp. 619. Date of Electronic Publication: 2021 Dec 28. - Publication Year :
- 2021
-
Abstract
- Objectives: To evaluate the impact of autoantibodies against the M2-muscarinic receptor (anti-M2-R) on the clinical outcomes of patients receiving the standard treatment for peripartum cardiomyopathy (PPCM).<br />Methods: A total of 107 PPCM patients who received standard heart failure (HF) treatment between January 1998 and June 2020 were enrolled in this study. According to anti-M2-R reactivity, they were classified into negative (n = 59) and positive (n = 48) groups, denoted as the anti-M2-R (-) and anti-M2-R (+) groups. Echocardiography, 6-min walk distance, serum digoxin concentration (SDC), and routine laboratory tests were performed regularly for 2 years. The all-cause mortality, cardiovascular mortality, and rehospitalisation rate for HF were compared between the two groups.<br />Results: A total of 103 patients were included in the final data analysis, with 46 in the anti-M2-R (+) group and 57 in the anti-M2-R (-) group. Heart rate was lower in the anti-M2-R (+) group than in the anti-M2-R (-) group at the baseline (102.7 ± 6.1 bpm vs. 96.0 ± 6.4 bpm, p < 0.001). The initial SDC was higher in the anti-M2-R (+) group than in the anti-M2-R (-) group with the same dosage of digoxin (1.25 ± 0.45 vs. 0.78 ± 0.24 ng/mL, p < 0.001). The dosages of metoprolol and digoxin were higher in the anti-M2-R (-) patients than in the anti-M2-R (+) patients (38.8 ± 4.6 mg b.i.d. vs. 27.8 ± 5.3 mg b.i.d., p < 0.0001, respectively, for metoprolol; 0.12 ± 0.02 mg/day vs. 0.08 ± 0.04 mg/day, p < 0.0001, respectively, for digoxin). Furthermore, there was a greater improvement in cardiac function in the anti-M2-R (-) patients than in the anti-M2-R (+) patients. Multivariate analysis identified negativity for anti-M2-R as the independent predictor for the improvement of cardiac function. Rehospitalisation for HF was lower in the anti-M2-R (-) group, but all-cause mortality and cardiovascular mortality were the same.<br />Conclusions: There were no differences in all-cause mortality or cardiovascular mortality between the two groups. Rehospitalisation rate for HF decreased in the anti-M2-R (-) group. This difference may be related to the regulation of the autonomic nervous system by anti-M2-R.<br /> (© 2021. The Author(s).)
- Subjects :
- Adult
Autoimmunity
Autonomic Nervous System physiopathology
Cardiomyopathies immunology
Cardiomyopathies mortality
Cardiomyopathies physiopathology
Female
Humans
Patient Readmission
Peripartum Period
Pregnancy
Pregnancy Complications, Cardiovascular immunology
Pregnancy Complications, Cardiovascular mortality
Pregnancy Complications, Cardiovascular physiopathology
Prospective Studies
Puerperal Disorders immunology
Puerperal Disorders mortality
Puerperal Disorders physiopathology
Recovery of Function
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Ventricular Function, Left drug effects
Autoantibodies blood
Autonomic Nervous System drug effects
Cardiomyopathies drug therapy
Cardiovascular Agents therapeutic use
Heart innervation
Pregnancy Complications, Cardiovascular drug therapy
Puerperal Disorders drug therapy
Receptor, Muscarinic M2 immunology
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2261
- Volume :
- 21
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC cardiovascular disorders
- Publication Type :
- Academic Journal
- Accession number :
- 34963460
- Full Text :
- https://doi.org/10.1186/s12872-021-02414-7