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Importance of Early Diagnosis in Peripartum Cardiomyopathy
Study Questions:
How is recovery after peripartum cardiomyopathy (PPCM) influenced by hypertensive disorders of pregnancy (HDP), timing of diagnosis, and race?
Methods:
This is a retrospective single-center cohort study of patients with PPCM (1986-2016) at the University of Pennsylvania. Variables were extracted via electronic medical record and manual chart review. Early diagnosis was defined as within the first month of delivery. The primary outcome was myocardial recovery defined as left ventricular ejection fraction (LVEF) >50%. Secondary outcomes were time to recovery and adverse cardiovascular events.
Results:
Of 180 patients with PPCM and known HDP status, 53% were black, and median follow-up was 42.6 months. Patients with HDP were diagnosed earlier postpartum (p = 0.013) and had similar rates of LVEF recovery (68% vs. 63%, p = 0.43), compared to those without HDP. Black women were diagnosed later, had lower baseline LVEF, and had lower rates of recovery. Patients with early diagnosis (<1 month postpartum) had higher baseline LVEF at the time of diagnosis and higher rates of LVEF recovery (70% vs. 54%, p = 0.035) than those diagnosed later.
Conclusions:
Patients with PPCM diagnosed within the first month postpartum have higher rates of LVEF recovery, likely related to the higher LVEF at the time of diagnosis in this group.
Perspective:
Outcomes are variable after a diagnosis of PPCM. Adverse prognostic factors have included black race, lower LVEF at the time of diagnosis, and delays in diagnosis. The influence of HDP on prognosis has been unclear. This study demonstrated that although HDP have been associated with the development of PPCM, the presence of HDP did not influence the prognosis or rate of recovery among women with PPCM. In this cohort, black women were more likely to be diagnosed later and have lower LVEF at the time of diagnosis, and thus, had lower rates of recovery. Earlier identification of PPCM should be prioritized, especially in at-risk populations, with the hope that earlier initiation of evidence-based medications could lead to higher rates of recovery and improved outcomes.
Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Hypertension
Keywords: AHA19, AHA Annual Scientific Sessions, African Americans, Cardiomyopathies, Early Diagnosis, Electronic Health Records, Healthcare Disparities, Heart Failure, Hypertension, Peripartum Period, Postpartum Period, Pregnancy, Risk Factors, Secondary Prevention, Stroke Volume, Women
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