Peripartum cardiomyopathy tied to risks at future pregnancy whether or not LV function recovers: JACC
USA: A recent study has suggested that subsequent pregnancies in women with peripartum cardiomyopathy (PPCM) are associated with adverse events, regardless of whether their left ventricular (LV) function recovers. The study was published online in the July 2023 issue of the Journal of the American College of Cardiology (JACC).
Peripartum cardiomyopathy is idiopathic heart failure with LV ejection fraction (LVEF) of 45% or less in the last month of pregnancy through the following five months.
Pavida Pachariyanon, Louisiana State University Health, Shreveport, Louisiana, USA, and colleagues looked at the long-term outcomes in women with PPCM who became pregnant again after several years, comparing those with LV function that had "normalized" in the interim versus those with persisting LV dysfunction.
The researchers found that adverse maternal outcomes five years following an index pregnancy were significantly worse among those with LV dysfunction persisted than those with recovered LV function. Relapsed PPCM risk persisted out to 8 years. In both groups, mortality remained high through the follow-up.
The researchers conducted a retrospective review of 137 PPCMs. A comparison was drawn between echocardiographic and clinical findings among the recovery group (RG) and nonrecovery group (NRG), defined as left ventricular ejection fraction ≥50% and <50% after an index of pregnancy, respectively.
The study included forty-five patients with subsequent pregnancies (SSPs) with a mean age of 27.0 ± 6.1 years. 66.7% of women were in the recovery group.
The study led to the following findings:
- SSPs were associated with a decrease in mean left ventricular ejection fraction from 45.1% ± 13.7% to 41.2% ± 14.5%.
- At five years, adverse outcomes were significantly higher in the NRG compared with the RG (53.3% vs 20%), driven by relapse PPCM (53.3% vs 20.0%).
- Five-year all-cause mortality was 13.33% in the NRG compared with 3.33% in the RG.
- At a median follow-up of 8 years, adverse outcomes and all-cause mortality rates were similar in the NRG and RG (53.3% vs 33.3% and 20% vs 20%, respectively).
"Subsequent pregnancies in women with PPCM are linked with adverse events," the researchers wrote. "The normalization of LV function does not guarantee a favourable outcome in the SSPs."
"Findings suggest that women with PPCM need long-term follow-up by cardiology, as mortality does not abate over time," they concluded.
The authors wrote that women with a history of PPCM need "multidisciplinary and shared decision-making for family planning because normalization of left ventricular function after index pregnancy does not guarantee a favourable outcome in the subsequent pregnancies."
Reference:
Pachariyanon P, Bogabathina H, Jaisingh K, Modi M, Modi K. Long-Term Outcomes of Women With Peripartum Cardiomyopathy Having Subsequent Pregnancies. J Am Coll Cardiol. 2023 Jul 4;82(1):16-26. doi: 10.1016/j.jacc.2023.04.043. PMID: 37380299.
