Clinical and echocardiographic profile and outcomes of peripartum cardiomyopathy: the Philippine General Hospital experience

Hypertensive Disorders of Pregnancy and Peripartum Cardiomyopathy: A Meta-Analysis of Prevalence and Impact on Left Ventricular Function and Mortality

Background: The purpose of this meta-analysis was to examine the prevalence of hypertensive disorders of pregnancy (HDPs), particularly preeclampsia (PE), in peripartum cardiomyopathy (PPCM)-affected pregnancies, and to evaluate whether a HDP significantly alters the prognosis of PPCM, with specific reference to the recovery of left ventricular function (LVEF) and mortality. Methods: A total of 5468 potentially eligible studies were identified, and 104 were included in the meta-analysis. For pooling proportions, the inverse variance methods with logit transformation were used. Complete recovery of LVEF (>50%) and mortality were expressed by odds ratios (ORs), with 95% confidence intervals (CIs). The Peto OR (POR) was used in cases of rare events. Baseline LV function and baseline LV end-diastolic diameter (LVEDD) were summarized by the mean difference (MD) and 95% confidence interval (CI). Results: The summary estimate of the prevalence of HDPs and PE in women with PPCM was 36% and 25%, respectively. Patients with HDPs and, more specifically, PE with PPCM had a higher chance of complete recovery (OR = 1.87; 95%CI = 1.64 to 2.13; p < 0.001 and OR = 1.98; 95%CI 1.69 to 2.32; p < 0.001, respectively), a higher baseline LVEF (MD, 1.42; 95% CI 0.16 to 2.67; p = 0.03 and MD, 1.69; 95% CI 0.21 to 3.18; p = 0.03, respectively), and a smaller baseline LVEDD (MD, -1.31; 95% CI -2.50 to -0.13; p = 0.03 and MD, -2.63; 95% CI -3.75 to -1.51; p < 0.001, respectively). These results, however, did not translate into a significant difference in 12-month mortality (POR = 0.80; 95% CI = 0.57 to 1.13; p = 0.21 and POR = 1.56; 95% CI 0.90 to 2.73; p = 0.12, respectively). Conclusions: The findings of this study may contribute to evidence that can be utilized to aid in the risk stratification of patients with PPCM regarding their long-term prognoses.

Peripartum Cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a form of heart failure that occurs toward the end of pregnancy or in the months following pregnancy and is marked by left ventricular systolic dysfunction. The cause of PPCM remains unknown and there is no diagnostic test specific to PPCM. Outcomes vary and include complete left ventricular recovery, persistent cardiac dysfunction, transplant, and death. Numerous advances have been made in understanding this disease, but many knowledge gaps remain. This article reviews recent data and recommendations for clinical practice in addition to highlighting the multiple knowledge gaps related to PPCM that warrant further investigation.

Clinical Profi le and Predictors of Outcomes of Patients with Peripartum Cardiomyopathy: The Philippine Heart Center Experience

BACKGROUND

Peripartum cardiomyopathy is a rare form of dilated cardiomyopathy characterized by heart failure and left ventricular dysfunction associated with pregnancy. While clinical characteristics of these patients have been previously described in literature, there is limited data regarding the natural history and predictors of outcomes of these patients in Asia, most specifi cally in Filipino patients.

METHODS

Clinical and echocardiographic data of 39 patients diagnosed with peripartum cardiomyopathy were analyzed. Patients were followed up for the occurrence of death and major adverse events (MAE) and outcomes were correlated with patient variables.

RESULTS

The mean age of the patients was 28.4 ± 6.9 and the mean ejection fraction (EF) was 27.8 ± 8.4%. Heart failure was the most common symptom (98%) while arrhythmia was the initial presentation in 5 patients (12.8%). 14 patients had recovery of ejection fraction in 6 months (39%) with a mean EF of 55.5 ± 6.3. 16 patients had an initial EF of <25% (41%) and only 2 patients in this subgroup experienced improvement in EF. 29 patients experienced death and/or MAEs (74.4%). Multivariate analysis showed that an EF of <25% (HR 12.0,p=0.019), recovery of LV function (HR 0.23,p=0.05) and improvement of EF in 6 months (HR 0.32,p=0.024) were signifi cant predictors of MAEs. Kaplan Meier curves showed that patients whose ejection fraction was <25% had a 50% incidence of MAEs in 1 year with an increasing trend. Patients whose EF recovered in 6 months experienced a 60% freedom from MAE for almost 6 years. Patients with an EF of <25% had a mortality rate of 50% in two years. Patients with an EF of >25% had a 90% likelihood of survival for 8 years with a higher trend of mortality for patients whose EF did not recover in 6 months.

CONCLUSION

Peripartum cardiomyopathy is associated with signifi cant morbidity and mortality. The degree of left ventricular dysfunction on presentation as well as improvement of EF within 6 months were predictive for the occurrence of death and major adverse events. This study emphasizes the need for aggressive treatment as well as clinical and echocardiographic follow up early in the course of disease in order to improve outcomes.