Affiliation:
1. Providence VA Medical Center Warren Alpert Medical School of Brown University 830 Chalkstone Ave Providence RI 02809 USA
2. Lifespan Cardiovascular Institute Warren Alpert Medical School of Brown University Providence RI USA
3. Brigham and Women's Hospital and the VA Boston Healthcare System Harvard Medical School Boston MA USA
4. Intermountain Medical Center Salt Lake City UT USA
5. Smidt Heart Institute Cedars Sinai Medical Center Los Angeles CA USA
6. Cardiovascular Institute, Perelman School of Medicine University of Pennsylvania Philadelphia PA USA
7. Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA
Abstract
AbstractAimsWe sought to identify factors associated with right ventricular (RV) dysfunction and elevated pulmonary artery systolic pressure (PASP) and association with adverse outcomes in peripartum cardiomyopathy (PPCM).Methods and resultsWe conducted a multi‐centre cohort study to identify subjects with PPCM with the following criteria: left ventricular ejection fraction (LVEF) < 40%, development of heart failure within the last month of pregnancy or 5 months of delivery, and no other identifiable cause of heart failure with reduced ejection fraction. Outcomes included a composite of (i) major adverse events (need for extracorporeal membrane oxygenation, ventricular assist device, orthotopic heart transplantation, or death) or (ii) recurrent heart failure hospitalization. RV function was obtained from echocardiogram reports. In total, 229 women (1993–2017) met criteria for PPCM. Mean age was 32.4 ± 6.8 years, 28% were of African descent, 50 (22%) had RV dysfunction, and 38 (17%) had PASP ≥ 30 mmHg. After a median follow‐up of 3.4 years (interquartile range 1.0–8.8), 58 (25%) experienced the composite outcome of adverse events. African descent, family history of cardiomyopathy, LVEF, and PASP were significant predictors of RV dysfunction. Using Cox proportional hazards models, we found that women with RV dysfunction were three times more likely to experience the adverse composite outcome: hazard ratio 3.21 (95% confidence interval: 1.11–9.28), P = 0.03, in a multivariable model adjusting for age, race, body mass index, preeclampsia, hypertension, diabetes, kidney disease, and LVEF. Women with PASP ≥ 30 mmHg had a lower probability of survival free from adverse events (log‐rank P = 0.04).ConclusionsAfrican descent and family history of cardiomyopathy were significant predictors of RV dysfunction. RV dysfunction and elevated PASP were significantly associated with a composite of major adverse cardiac events. This at‐risk group may prompt closer monitoring or early referral for advanced therapies.
Funder
National Institute of General Medical Sciences
Subject
Cardiology and Cardiovascular Medicine