Peripartum cardiomyopathy in Italy: updated insights from a national registry on left ventricle recovery and the role of mechanical support

Background Peripartum cardiomyopathy is a rare, life-threatening heart failure occurring in late pregnancy or early postpartum, with variable presentation and outcomes. In some cases, it may progress to severe LV dysfunction and cardiogenic shock, potentially requiring pharmacological or mechanical circulatory support (MCS). MCS use in PPCM remains unclear. The aim of this analysis is to report clinical and echocardiographic data from the Italian PPCM Registry (1), to better define recovery patterns and the need of MCS in this population. Methods Women ≥18 years with confirmed PPCM diagnosis were included based on: HF onset in the last month of pregnancy or within 5 months postpartum, left ventricle ejection fraction ≤45%, and no prior heart disease or identifiable HF cause. Data included clinical features, echocardiographic parameters, and blood samples for multi-omics profiling. Results Thirty-seven women (median age 37 [IQR 33.5 – 42.5] years) were enrolled. Hypertensive disorders occurred in 50%, pre-eclampsia in 10.8%, and 29.7% were overweight. 8.11% of patient were of African Ethnicity. Most presented with NYHA class III/IV symptoms within 1 month postpartum. Arrhythmic presentation occurred in 24.32%. Persistent severe LV dysfunction (LVEF<35%) was observed in 13.5%. Despite initial severity, 43% achieved full systolic recovery; no deaths occurred. Echocardiographic parameters significantly differed by LV-recovery status. Patients with persistent dysfunction (LVEF<35%) had larger LV end-diastolic diameters (138 [IQR 119 – 250] in LVEF<35% group vs 134 [98.7 – 158] for LVEF 35%<LVEF<50%,> 50%, p= 0.019), worse LV global longitudinal strain (10 [IQR 10-10] vs 13 [11.2 – 17] vs 19 [15.5 – 20] p=0.0032), and lower TAPSE (17 [12.5 - 20.5] vs 22 [20 -24.5] vs 25 [21-25], p=0.011). LVEF tended to be slightly higher in patients receiving prolactin blockers (50; [IQR 45–68] vs. 49.5 [IQR 42.25–55.25]), although the difference was not statistically significant (p=0.503). Notably, no patient required MCS during the acute phase, despite the often severe initial presentation. Conclusion PPCM in this national cohort showed heterogeneous clinical and imaging features, with frequent severe onset but generally favorable outcomes. No patient required MCS, suggesting that even marked dysfunction may recover with medical therapy alone. However, disease severity appeared less pronounced than in MCS-treated cohorts (2, 3), underscoring its role in carefully selected cases. Ongoing multi-omics analyses may help identify biological mechanisms underlying early severe presentations and variable recovery trajectories. </LVEF<50%,><LVEF<50%,> </LVEF<50%,>For image description, please refer to the figure legend and surrounding text.