Myocardial Recovery and Outcomes in Peripartum Cardiomyopathy
What are the predictors of recovery in peripartum cardiomyopathy (PPCM)?
Women enrolled in the multicenter IPAC Study (Investigations of Pregnancy-Associated Cardiomyopathy) were included and followed through the first postpartum year. Outcomes were evaluated at 6 and 12 months and included left ventricular ejection fraction (LVEF) and survival free from transplant or left ventricular assist device. Determinants of outcomes were also analyzed.
Event-free survival at 1 year was 93%. Transplant-free survival was 95%. At 12 months, 72% of patients achieved an LVEF ≥50%. Event-free survival was significantly worse for women with LVEF <30% (99% with LVEF ≥30% vs. 82% with LVEF <30%, p = 0.004). Black women had significantly lower LVEF at baseline, 6 months, and 12 months than white women, although similar change in LVEF over time. Women with more severe LV dysfunction had significantly lower LVEF at 6 and 12 months. Univariate predictors of LVEF at 12 months included race, baseline LVEF, body mass index, and days post-partum to entry into study; however, on multivariate analysis, only race and LV end-diastolic dimension (LVEDD) remained significant. Women with LVEDD <6 cm had a better LVEF at 6 and 12 months.
These data suggest that most women with PPCM recover LV function. Race and LV remodeling are significant predictors of recovery in PPCM.
The current study provides evidence that complete recovery of LV function in patients with PPCM is more common than previously thought, and occurs in the majority of women. Greater LV dilatation and black race are associated with less recovery, and could potentially serve as targets for investigation.
Keywords: Cardiomyopathies, Heart Failure, African Americans, Body Mass Index, Dilatation, Disease-Free Survival, Heart-Assist Devices, Peripartum Period, Postpartum Period, Pregnancy, Stroke Volume
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