Key result
~72% of women with peripartum cardiomyopathy recover LVEF by 1 year under standard therapy.
Why the study?
Peripartum cardiomyopathy remains a major cause of maternal morbidity and mortality, prompting prospective evaluation of left ventricular ejection fraction recovery and clinical outcomes.
What are the clinical outcomes and predictors of left ventricular recovery in women with peripartum cardiomyopathy?
Cohort (n=100)
Yes
What are the clinical outcomes and predictors of left ventricular recovery in women with peripartum cardiomyopathy?
Most women with peripartum cardiomyopathy recover normal LV function by 1 year, but black race and severe initial LV dilation/dysfunction predict poorer recovery.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The results … demonstrated significant recovery in the majority of women with [peripartum cardiomyopathy] and should be very encouraging to women presenting with this disorder and to their physicians. Unfortunately, adverse outcomes remain unacceptably high. … There remains a great need for more targeted therapies to improve outcomes in those women whose probability of recovery on conventional therapy is diminished.”
“Many questions still need to be addressed, such as the risk of recurrent HF after additional pregnancies in patients with [peripartum cardiomyopathy]. The multicenter framework of this large cohort will likely continue to add new insights into this rare and potentially devastating cardiomyopathy.”
May guide counseling and surveillance intensity in peripartum cardiomyopathy; leaves open prospective trials targeting severe baseline dysfunction.
BACKGROUND: Peripartum cardiomyopathy (PPCM) remains a major cause of maternal morbidity and mortality. OBJECTIVES: This study sought to prospectively evaluate recovery of the left ventricular ejection fraction (LVEF) and clinical outcomes in the multicenter IPAC (Investigations of Pregnancy Associated Cardiomyopathy) study. METHODS: We enrolled and followed 100 women with PPCM through 1 year post-partum. The LVEF was assessed by echocardiography at baseline and at 2, 6, and 12 months post-partum. Survival free from major cardiovascular events (death, transplantation, or left ventricular [LV] assist device) was determined. Predictors of outcome, particularly race, parameters of LV dysfunction (LVEF), and remodeling (left ventricular end-diastolic diameter [LVEDD]) at presentation, were assessed by univariate and multivariate analyses. RESULTS: The cohort was 30% black, 65% white, 5% other; the mean patient age was 30 ± 6 years; and 88% were receiving beta-blockers and 81% angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. The LVEF at study entry was 0.35 ± 0.10, 0.51 ± 0.11 at 6 months, and 0.53 ± 0.10 at 12 months. By 1 year, 13% had experienced major events or had persistent severe cardiomyopathy with an LVEF <0.35, and 72% achieved an LVEF ≥0.50. An initial LVEF <0.30 (p = 0.001), an LVEDD ≥6.0 cm (p < 0.001), black race (p = 0.001), and presentation after 6 weeks post-partum (p = 0.02) were associated with a lower LVEF at 12 months. No subjects with both a baseline LVEF <0.30 and an LVEDD ≥6.0 cm recovered by 1 year post-partum, whereas 91% with both a baseline LVEF ≥0.30 and an LVEDD <6.0 cm recovered (p < 0.00001). CONCLUSIONS: In a prospective cohort with PPCM, most women recovered; however, 13% had major events or persistent severe cardiomyopathy. Black women had more LV dysfunction at presentation and at 6 and 12 months post-partum. Severe LV dysfunction and greater remodeling at study entry were associated with less recovery. (Investigations of Pregnancy Associated Cardiomyopathy [IPAC]; NCT01085955).
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McNamara et al. (2015) conducted a cohort in Peripartum cardiomyopathy (n=100). Peripartum cardiomyopathy was evaluated on Recovery of left ventricular ejection fraction (LVEF ≥0.50) at 1 year post-partum. In a prospective cohort of women with peripartum cardiomyopathy, 72% recovered to an LVEF ≥0.50 by 1 year, while severe baseline LV dysfunction and greater remodeling predicted less recovery.
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