June 11, 2021European Journal of Heart FailureOpen Access

Hypertensive disorders in women with peripartum cardiomyopathy: insights from the ESC EORP PPCM Registry

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Why the study?

How often hypertensive disorders co-exist in women with peripartum cardiomyopathy, and to what extent they impact outcomes, remains unclear.

Do hypertensive disorders during pregnancy affect clinical outcomes and left ventricular recovery in women with peripartum cardiomyopathy?

Structured PICO

Do hypertensive disorders during pregnancy affect clinical outcomes and left ventricular recovery in women with peripartum cardiomyopathy?

Population

735 women with peripartum cardiomyopathy (PPCM) enrolled in the European Society of Cardiology EURObservational Research Programme PPCM Registry from 2012-2018

Intervention

Hypertensive disorders during pregnancy (hypertension without pre-eclampsia [PPCM-HTN] or pre-eclampsia [PPCM-PE])

Comparator

No hypertension during pregnancy (PPCM-noHTN)

Outcome

Maternal (6-month) and neonatal outcomes (including death from any cause, rehospitalization for any cause, stroke, thromboembolic events, left ventricular recovery, and adverse neonatal outcomes)hard clinical

In women with peripartum cardiomyopathy, pre-eclampsia is associated with more severe initial heart failure symptoms but a higher likelihood of left ventricular recovery, alongside an increased risk of adverse neonatal outcomes.

Implication

Alerts to higher neonatal risk in PPCM-PE despite better LV recovery; leaves open causality and mechanisms for prospective study.

Abstract

AIMS: Hypertensive disorders occur in women with peripartum cardiomyopathy (PPCM). How often hypertensive disorders co-exist, and to what extent they impact outcomes, is less clear. We describe differences in phenotype and outcomes in women with PPCM with and without hypertensive disorders during pregnancy. METHODS AND RESULTS: The European Society of Cardiology EURObservational Research Programme PPCM Registry enrolled women with PPCM from 2012-2018. Three groups were examined: (i) women without hypertension (PPCM-noHTN); (ii) women with hypertension but without pre-eclampsia (PPCM-HTN); (iii) women with pre-eclampsia (PPCM-PE). Maternal (6-month) and neonatal outcomes were compared. Of 735 women included, 452 (61.5%) had PPCM-noHTN, 99 (13.5%) had PPCM-HTN and 184 (25.0%) had PPCM-PE. Compared to women with PPCM-noHTN, women with PPCM-PE had more severe symptoms (New York Heart Association class IV in 44.4% vs. 29.9%, P < 0.001), more frequent signs of heart failure (pulmonary rales in 70.7% vs. 55.4%, P = 0.002), a higher baseline left ventricular ejection fraction (LVEF) (32.7% vs. 30.7%, P = 0.005) and a smaller left ventricular end-diastolic diameter (57.4 ± 6.7 mm vs. 59.8 ± 8.1 mm, P = 0.001). There were no differences in the frequencies of death from any cause, rehospitalization for any cause, stroke, or thromboembolic events. Compared to women with PPCM-noHTN, women with PPCM-PE had a greater likelihood of left ventricular recovery (LVEF ≥ 50%) (adjusted odds ratio 2.08, 95% confidence interval 1.21-3.57) and an adverse neonatal outcome (composite of termination, miscarriage, low birth weight or neonatal death) (adjusted odds ratio 2.84, 95% confidence interval 1.66-4.87). CONCLUSION: Differences exist in phenotype, recovery of cardiac function and neonatal outcomes according to hypertensive status in women with PPCM.