Association Between Right Ventricular Dysfunction and Adverse Outcomes in Peripartum Cardiomyopathy: Insights From the BRO-HF Quebec Cohort Study

Pacheco, Christine; Tremblay-Gravel, Maxime; Marquis‐Gravel, Guillaume; Couture, Étienne; Avram, Robert; Desplantie, O.; Bibas, Lior; Simard, François; Malhamé, Isabelle; Poulin, Anthony; Tran, Dan B.; Sénéchal, Mario; Afilalo, Jonathan; Farand, Paul; Bérubé, L.; Jolicœur, E. Marc; Ducharme, Anique; Tournoux, François

doi:10.1016/j.cjco.2022.05.004

Cited by 3 publications

(4 citation statements)

References 39 publications

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“… 14 In a retrospective analysis from the Bromocriptine in Heart Failure (BRO‐HF) study ( n = 67), those with RV dysfunction had higher odds of the need for mechanical support (OR 10.10, 95% CI: 1.86–54.8) but not LVEF recovery, cardiac transplantation, heart failure hospitalization, or death at 6 months. 15 A study of 45 patients in Nigeria did not find a significant association with RV dysfunction and mortality at 6 months. 22 Another study of women with PPCM ( n = 34) found that RV dysfunction was associated with lower chance of LVEF recovery at 5 months.…”

Section: Discussionmentioning

confidence: 94%

“…In a cohort of 53 patients, moderate to severe RV dysfunction was independently associated with a composite outcome of LV assist device implantation, cardiac transplantation, or death in a model adjusting for LVEF and LV end‐diastolic dimension (HR 3.21, 95% CI: 1.13–9.10) 14 . In a retrospective analysis from the Bromocriptine in Heart Failure (BRO‐HF) study ( n = 67), those with RV dysfunction had higher odds of the need for mechanical support (OR 10.10, 95% CI: 1.86–54.8) but not LVEF recovery, cardiac transplantation, heart failure hospitalization, or death at 6 months 15 . A study of 45 patients in Nigeria did not find a significant association with RV dysfunction and mortality at 6 months 22 .…”

Section: Discussionmentioning

confidence: 99%

“…Prior small cohort studies found that RV systolic dysfunction was an independent predictor of absence of LV systolic function recovery and greater need for mechanical support in PPCM. 13 , 14 , 15 In addition, pulmonary hypertension, which can be assessed via pulmonary artery systolic pressure (PASP), is known to result in diminished exercise capacity, and quality of life, and a high mortality in patients with left‐sided heart disease overall. 16 , 17 , 18 , 19 Even a slight increase in pulmonary artery pressures within the upper end of the traditional normal range has been found to correlate with greater mortality.…”

Section: Introductionmentioning

confidence: 99%

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Clinical predictors of right ventricular dysfunction and association with adverse outcomes in peripartum cardiomyopathy

Imran,

Ataklte,

Khalid

et al. 2023

ESC Heart Failure

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AimsWe 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.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical predictors of right ventricular dysfunction and association with adverse outcomes in peripartum cardiomyopathy

Imran,

Ataklte,

Khalid

et al. 2023

ESC Heart Failure

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“…Echocardiography can help predict prognosis and / or recovery in PPCM [28]; a left ventricular ejection fraction of ≤ 30% at presentation confers a poorer prognosis and reduced likelihood of recovery [28], as does a global longitudinal strain of > -10.6%, global circumferential strain of < 10.1% [29], and left ventricular end diastolic diameter (LVEDd) of ≥ 6 cm [28]. Impaired right ventricular (RV) function co-exists in a quarter to a third of women with PPCM [30][31][32]. Again, echocardiographic measurements can be indicative of a poorer prognosis: TAPSE (tricuspid annular plane systolic excursion) < 16 mm, TDI peak Sʹ velocity of < 10 cm/s [32], fractional area change < 36%, and right ventricular end systolic area > 13 cm 2 [33].…”

Section: Peripartum Cardiomyopathymentioning

confidence: 99%

Transthoracic Echocardiographic Assessment of the Heart in Pregnancy—a position statement on behalf of the British Society of Echocardiography and the United Kingdom Maternal Cardiology Society

et al. 2023

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Pregnancy is a dynamic process associated with profound hormonally mediated haemodynamic changes which result in structural and functional adaptations in the cardiovascular system. An understanding of the myocardial adaptations is important for echocardiographers and clinicians undertaking or interpreting echocardiograms on pregnant and post-partum women. This guideline, on behalf of the British Society of Echocardiography and United Kingdom Maternal Cardiology Society, reviews the expected echocardiographic findings in normal pregnancy and in different cardiac disease states, as well as echocardiographic signs of decompensation. It aims to lay out a structure for echocardiographic scanning and surveillance during and after pregnancy as well as suggesting practical advice on scanning pregnant women.

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Perioperative echocardiographic strain analysis: what anesthesiologists should know

Costescu,

Riendeau Beaulac,

Guensch

et al. 2024

Can J Anesth/J Can Anesth

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Association Between Right Ventricular Dysfunction and Adverse Outcomes in Peripartum Cardiomyopathy: Insights From the BRO-HF Quebec Cohort Study

Cited by 3 publications

References 39 publications

Clinical predictors of right ventricular dysfunction and association with adverse outcomes in peripartum cardiomyopathy

Clinical predictors of right ventricular dysfunction and association with adverse outcomes in peripartum cardiomyopathy

Transthoracic Echocardiographic Assessment of the Heart in Pregnancy—a position statement on behalf of the British Society of Echocardiography and the United Kingdom Maternal Cardiology Society

Perioperative echocardiographic strain analysis: what anesthesiologists should know

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