Study population

A total of 64 consecutive patients diagnosed with PPCM in our tertiary reference center between April 2009 and May 2017 were included in this retrospective analysis. PPCM was defined as an occurrence of unexplained heart failure with LVEF < 45%, presenting toward the end of pregnancy or in the first months after delivery in previously healthy women [1]. All women were at least 18 years of age. Exclusion criteria were having a history of cardiomyopathy, severe organic valvular heart disease, significant coronary heart disease (≥50% luminal diameter stenosis in at least 1 major coronary arteries and their branches), clinical conditions other than cardiomyopathy that could increase plasma levels of inflammatory markers such as active cancer, active infection, chronic inflammatory disease, chronic antihyperlipidemic treatment, and patients without a recorded measurement of admission laboratory parameters were excluded from this study. Data regarding clinical and demographic features and laboratory parameters were obtained from the patients’ medical records. The follow-up duration was at least 12 months after diagnosis of PPCM for all patients. Standard, 2-dimensional and Doppler echocardiographic measurements were performed in all women at the time of diagnosis and the last follow-up visit. LVEF was measured using the Modified Simpson rule. Recovery of LV systolic function was accepted as the presence of LVEF >45%, whereas non-recovery (persistent left ventricular systolic dysfunction) was defined as the presence of LVEF≤45% at last follow-up visit.

Fasting venous blood samples were collected at baseline in pre-cooled EDTA tubes for the hematological test and dry tubes for biochemical analyses. The HDL-C concentration was determined by selective solubilization method (Determiner L HDL, Kyowa Medex, Tokyo, Japan). WBC counts were measured using an automated hematology analyzer XE-1200 (Sysmex, Kobe, Japan). Baseline MHR was calculated by dividing the absolute count of the monocytes by the complete counts of the HDL-C. The local ethics committee approved the study protocol.