Race, Hypertensive Disorders of Pregnancy and Outcomes in Peripartum Cardiomyopathy

Introduction Black women with peripartum cardiomyopathy (PPCM) have a high prevalence of hypertensive disorders of pregnancy (HDP) and worse clinical outcomes compared with other races. We examined the role of HDP and race on myocardial recovery in women with PPCM. Methods A total of 100 women were enrolled into the Investigation in Pregnancy Associated Cardiomyopathy (IPAC) study. A hypertensive disorder of pregnancy (HDP) was defined as a gestational hypertension and preeclampsia, chronic hypertension was not included in the HDP subgroup. Left ventricular ejection fraction (LVEF) was assessed by echocardiography at entry, 6, and 12-months post-partum (PP). Clinical outcomes including persistent cardiomyopathy (LVEF≤35%), left ventricular assist device, (LVAD), transplantation, or death at 12-months were examined with and without HDP and between Black and non-Black subsets of women. Results Mean age in IPAC was 30±6 years, with a baseline LVEF of 35±10%. In Black women, those with HDP were more likely to present earlier (days PP HDP: 35±20 vs 54±27 days, P=0.03) compared to women without HDP. There was no difference in LVEF at study entry, but better recovery with HDP at 6 (HDP:0.52±0.11 vs no HDP:0.40±0.14, P=0.03) and 12-months (HDP:0.53±0.10 vs no HDP:0.40±0.16, P=0.02). At 12-months, Black women had a lower LVEF than non-Black women (P=0.007), driven by worse recovery in Black women without HDP (P=0.002). Black women with HDP had a similar LVEF to non-Black women (P=0.31). Conclusions In women with PPCM, HDP among Black women was associated with earlier presentation and better recovery compared to Black women without HDP.