Key result
HPD-PPCM links to less LVEF reduction and LV dilation versus PPCM alone.
Why the study?
Peripartum cardiomyopathy has high maternal morbidity and mortality, but clinical factors and echocardiographic findings had not been systematically compared between PPCM with co-incident hypertensive pregnancy disorders and PPCM alone.
Does the presence of co-existing hypertensive pregnancy disorder affect clinical profiles and echocardiographic remodeling in women with peripartum cardiomyopathy?
Meta-Analysis (n=64,649)
Does the presence of co-existing hypertensive pregnancy disorder affect clinical profiles and echocardiographic remodeling in women with peripartum cardiomyopathy?
Effect estimate: SMD -1.55 (95% CI -2.89 to -0.21)
p-value: p=0.02
Patients with HPD-PPCM exhibit less eccentric remodeling and a higher chance of LVEF recovery compared to PPCM alone, suggesting potential differences in response to standard heart failure therapies.
HPD co-occurrence may identify PPCM patients with more favorable remodeling; extends evidence for distinct phenotypes warranting targeted trials.
Peripartum cardiomyopathy (PPCM) is a form of new-onset heart failure that has a high rate of maternal morbidity and mortality. This was the first study to systematically investigate and compare clinical factors and echocardiographic findings between women with PPCM and co-incident hypertensive pregnancy disorders (HPD-PPCM) and PPCM-only women. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) framework. We used four databases and a single search engine, namely PubMed/Medline, Scopus, Web of Science, and Cochrane. We used Cochrane Risk of Bias (RoB) 2.0 for quality assessment. Databases were searched for relevant articles published from 2013 to the end of April 2023. The meta-analysis used the DerSimonian–Laird random-effects model to analyze the pooled mean difference (MD) and its p-value. We included four studies with a total of 64,649 participants and found that systolic blood pressure was significantly more likely to be associated with the PPCM group than the HPD-PPCM group (SMD = −1.63) (95% CI; −4.92,0.28, p = 0.01), while the other clinical profiles were not significant. HPD-PPCM was less likely to be associated with LVEF reduction (SMD = −1.55, [CI: −2.89, −0.21], p = 0.02). HPD-PPCM was significantly associated with less LV dilation (SMD = 1.81; 95% (CI 0.07–3.01), p = 0.04). Moreover, HPD-PPCM was less likely to be associated with relative wall thickness reduction (SMD = 0.70; 95% CI (−1.08–−0.33), p = 0.0003). In conclusion, PPCM and HPD-PPCM shared different clinical profiles and remodeling types, which may affect each disease’s response to pharmacological treatment. Patients with HPD-PPCM exhibited less eccentric remodeling and seemed to have a higher chance of recovering their LV ejection fraction, which means they might not benefit as much from ACEi/ARB and beta-blockers. The findings of this study will guide the development of guidelines for women with PPCM and HPD-PPCM from early detection to further management.
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Nugrahani et al. (2023) conducted a meta-analysis in Peripartum cardiomyopathy (PPCM) and PPCM with co-existing hypertensive pregnancy disorder (HPD-PPCM) (n=64,649). Hypertensive pregnancy disorder with PPCM (HPD-PPCM) vs. PPCM-only was evaluated on LVEF reduction (SMD -1.55, 95% CI -2.89 to -0.21, p=0.02). HPD-PPCM was associated with less LVEF reduction (SMD -1.55; 95% CI -2.89 to -0.21; p=0.02) and less LV dilation compared to PPCM alone.
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