Peripartum Cardiomyopathy: Predictors of Recovery and Current State of Implantable Cardioverter-Defibrillator Use
What are the predictors of left ventricular (LV) recovery in patients with peripartum cardiomyopathy (PPCM) and rates of implantable cardioverter-defibrillator (ICD) use?
This was a retrospective study of PPCM patients from two academic centers between January 1, 1999, and December 31, 2012. The study investigators reviewed clinical and demographic variables and delivery records of patients with a diagnosis of PPCM (International Classification of Diseases, 9th Revision code 674.5). Echocardiography reports were used to determine changes in LV function.
The study cohort comprised 100 PPCM patients, of whom 55% were African Americans, 39% were Caucasians, and 6% were Hispanic, with a mean age of 30 ± 6 years. The study investigators found that mean left ventricular ejection fraction (LVEF) at diagnosis was 28 ± 9% and that 42% of patients showed improvement in LVEF over a mean duration of 33 ± 21 months. Predictors of improvement in LVEF included postpartum diagnosis (hazard ratio, 3.0; p = 0.01) and Caucasian/Hispanic race (hazard ratio, 2.2; p = 0.01). Only 12% (7 of the 58) who did not have improvement in their LVEF had an ICD implanted. There were 11 deaths, with a trend toward higher mortality in those who did not display improved LV function (15% vs. 5%; p = 0.1).
The study authors concluded that more than one-third of women with PPCM improve LV function, with delayed recovery noted in the majority of these patients. Caucasians/Hispanics and those diagnosed in the postpartum period appear to be the most likely to recover.
The natural history of cardiomyopathy varies by etiology, with PPCM having a more ‘benign’ course compared to cardiomyopathy associated with HIV. This is an important study because it suggests that the prognosis of PPCM is worse in African American women and when the onset is intrapartum. Large multicenter registries of PPCM are now needed to validate the findings of this study, to develop better predictors of sudden death in PPCM, and to determine which PPCM patients are most likely to benefit from ICD/cardiac resynchronization.
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