Key result
Right ventricular dysfunction is linked to a ~3-fold higher composite adverse event risk in peripartum cardiomyopathy.
Why the study?
Factors associated with right ventricular dysfunction and elevated pulmonary artery systolic pressure, and their relationship with adverse outcomes in peripartum cardiomyopathy, needed to be identified.
Cohort (n=229)
Yes
Right ventricular dysfunction and elevated pulmonary artery systolic pressure at presentation are strong, independent predictors of major adverse cardiovascular events in women with peripartum cardiomyopathy.
Answers are grounded in this paper and cite their sources.
RV dysfunction may aid risk stratification in peripartum cardiomyopathy; leaves open whether targeted interventions improve outcomes.
AIMS: We sought to identify factors associated with right ventricular (RV) dysfunction and elevated pulmonary artery systolic pressure (PASP) and association with adverse outcomes in peripartum cardiomyopathy (PPCM). METHODS AND RESULTS: We conducted a multi-centre cohort study to identify subjects with PPCM with the following criteria: left ventricular ejection fraction (LVEF) < 40%, development of heart failure within the last month of pregnancy or 5 months of delivery, and no other identifiable cause of heart failure with reduced ejection fraction. Outcomes included a composite of (i) major adverse events (need for extracorporeal membrane oxygenation, ventricular assist device, orthotopic heart transplantation, or death) or (ii) recurrent heart failure hospitalization. RV function was obtained from echocardiogram reports. In total, 229 women (1993-2017) met criteria for PPCM. Mean age was 32.4 ± 6.8 years, 28% were of African descent, 50 (22%) had RV dysfunction, and 38 (17%) had PASP ≥ 30 mmHg. After a median follow-up of 3.4 years (interquartile range 1.0-8.8), 58 (25%) experienced the composite outcome of adverse events. African descent, family history of cardiomyopathy, LVEF, and PASP were significant predictors of RV dysfunction. Using Cox proportional hazards models, we found that women with RV dysfunction were three times more likely to experience the adverse composite outcome: hazard ratio 3.21 (95% confidence interval: 1.11-9.28), P = 0.03, in a multivariable model adjusting for age, race, body mass index, preeclampsia, hypertension, diabetes, kidney disease, and LVEF. Women with PASP ≥ 30 mmHg had a lower probability of survival free from adverse events (log-rank P = 0.04). CONCLUSIONS: African descent and family history of cardiomyopathy were significant predictors of RV dysfunction. RV dysfunction and elevated PASP were significantly associated with a composite of major adverse cardiac events. This at-risk group may prompt closer monitoring or early referral for advanced therapies.
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Imran et al. (2023) conducted a cohort in Peripartum cardiomyopathy (n=229). Right ventricular dysfunction vs. Normal right ventricular function was evaluated on Composite of major adverse events (need for extracorporeal membrane oxygenation, ventricular assist device, orthotopic heart transplantation, or death) or recurrent heart failure hospitalization (HR 3.21, 95% CI 1.11-9.28, p=0.03). Right ventricular dysfunction was associated with a significantly higher risk of a composite of major adverse cardiac events or recurrent heart failure hospitalization (HR 3.21) in women with peripartum cardiomyopathy.
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