RESEARCH ARTICLE


Long-term Outcomes in Peripartum Cardiomyopathy



Madeline K Mahowald1, 2, Nivedita Basu1, Latha Subramaniam1, Ryan Scott3, Melinda B. Davis4, 5, *
1 Department of Internal Medicine, University of Michigan, Michigan, USA
2 Department of Pediatrics, University of Michigan, Michigan, USA
3 Department of Anesthesiology, University of Michigan, Michigan, USA
4 Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Michigan, USA
5 Department of Obstetrics and Gynecology, University of Michigan, Michigan, USA


© 2019 Mahowald et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, Michigan, MI 48109, USA; Tel: 734-763-6003;Fax: 734-936-5256; E-mail: davismb@med.umich.edu


Abstract

Background:

Prior studies of Peripartum Cardiomyopathy (PPCM) are limited by short-term follow-up. Contemporary long-term outcomes and change in myocardial function over time are poorly characterized.

Methods and Results:

This retrospective cohort study included women with PPCM at the University of Michigan (2000-2011), with follow-up on March 31, 2017. Subsequent pregnancies were excluded. Recovery was sustained left ventricular Ejection Fraction (EF) ≥55%. Major Adverse Events (MAE) included death, cardiac transplantation, left ventricular assist device, or inotrope-dependence. A total of 59 women were included (mean [SD] age at diagnosis, 29.5 [6.8]; 28.8% Black), with a mean follow-up of 6.3 years. Recovery occurred in 22 women (37%); of these, 8 women (36%) had delayed recovery (>12 months). All cause mortality was 20% (12/59) with median survival 4.2 years; of these, 9 women (75%) died after the first year (range 2 - 10 years). MAE occurred in 19 women (32%); of these, 11 women (42%) had MAE >12 months from time of diagnosis (range 2-20 years). Deterioration in EF by >10% from the time of diagnosis occurred in 16 women (27%). This group had worse long-term outcomes, including lower final EF (mean 25 vs 42%, p=0.010), less recovery (12 vs 46%, p=0.016), and higher rates of death (38 vs 14%, p=0.046) and MAE (56 vs 23%, p=0.016).

Conclusion:

Women with PPCM have long-term risks of mortality, MAE, and subsequent decline in EF, even in the absence of a subsequent pregnancy. Deterioration in EF is associated with adverse events; thus, long-term management is important.

Keywords: Peripartum cardiomyopathy, Women, Non-ischemic cardiomyopathy, Outcomes, Post-partum cardiomyopathy, Pregnancy-associated cardiomyopathy.