Peripartum Cardiomyopathy: Predictors of Recovery

Abstract

Introduction: Peripartum Cardiomyopathy (PPCM) is a rare, but poorly understood disease process with significant clinical implications in pregnant women during and after delivery. Improvement in left ventricular (LV) ejection fraction (EF) varies widely and few studies exist that define predictors of improvement in LV function in this sub population. The use of implantable cardioverter defibrillator (ICD) has also not been clearly understood in this population. Methods: A retrospective study was conducted at 2 academic centers between January 1st 1999 and December 31st 2010. Clinical and demographic variables and delivery records of patients with a discharge or outpatient diagnosis of PPCM (ICD9 -674.5) were reviewed. Patients were followed over time until December 31st 2012 to assess improvement in LV function. Results: The total sample comprised 100 patients of whom 55% were African Americans, 39% were Caucasians and 6% were Hispanic with mean age of 30±6 years. The mean time to diagnosis after delivery was 1.1±4 weeks. Mean EF at diagnosis was 28±9%. Forty two percent of patients showed some improvement in LVEF over a mean duration of 33±21 months. Postpartum diagnosis (HR 3, p=0.01) and Caucasian/Hispanic race (HR 2.2, p=0.01) were predictors of LVEF improvement. Only 7 of the 58 patients (12%) who did not improve their EF, had ICD implanted. There were 11 deaths with a trend towards higher mortality in those that did not display improved LV function (15% vs. 5%, p=0.1). Conclusions: More than one-third of the women with PPCM improve LV function with delayed recovery noted in the majority of these women. Caucasians and those diagnosed postpartum seem to be most likely to recover. ICDs were underutilized for primary prevention of sudden cardiac death in this population.